Chronic Pain, Motor Output and Motor Learning in Knee Osteoarthritis

膝骨关节炎的慢性疼痛、运动输出和运动学习

• 批准号: 9099156
• 负责人: KATHERINE S RUDOLPH
• 金额: $ 44.8万
• 依托单位: UNIVERSITY OF NEW ENGLAND
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9099156
• 关键词: Address; Aerobic; Affect; Age; Americas; Arthritis; CNS processing; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Cognitive Therapy; Degenerative polyarthritis; Disease; Dyskinetic syndrome; Escalator; Exercise; Fright; Goals; Healed; Health; Institute of Medicine (U.S.); Intervention; Joints; Knee; Knee Osteoarthritis; Knee joint; Lead; Learning; Measures; Methods; Mind-Body Intervention; Motion; Motor; Motor output; Movement; Muscle; Nervous system structure; Neuraxis; One-Step dentin bonding system; Outcome; Pain; Pathology; Patients; Pattern; Perception; Peripheral; Physical therapy; Physiologic pulse; Population; Prevention; Process; Quality of life; Rehabilitation therapy; Relaxation; Reporting; Research; Self Efficacy; Sensory Process; Signal Transduction; Source; Specialist; Stimulus; Time; Tissues; Training; Training Programs; Walking; articular cartilage; central sensitization; chronic pain; common symptom; conditioning; daily functioning; design; education research; experience; hamstring; healing; improved; improved functioning; insight; joint destruction; knee replacement arthroplasty; meetings; middle age; motor control; motor learning; neuromuscular; programs; public health relevance; quadriceps muscle; response; sensory feedback; sex; success

 DESCRIPTION (provided by applicant): By 2030, it is estimated that 67 million people will have osteoarthritis (OA) in the US and the majority of them will have OA in the knee that begins in middle age. Patients endure pain for many years before they have a total knee replacement. The number of years that knee OA patients endure pain takes a toll on their knee function and quality of life but it also impacts how the nervous system processes pain signals. Central sensitization of pain is a heightened response to painful stimuli that is a protective mechanism designed to allow the body to heal. Under normal circumstances, central sensitization subsides when tissue healing is complete. However, sometimes central sensitization persists and pain is exaggerated or no longer originates from a peripheral source. This abnormal sensory processing can lead to misdiagnosis and poor outcomes to treatments because the source of the pain is in the central nervous system not in peripheral tissues. Central sensitization of pain has been demonstrated in people with knee OA and it is exacerbated by another anomalous pain mechanism: reduced conditioned pain modulation (CPM). CPM involves the application of a painful "conditioning stimulus" that elicits a reduction in the perception of pain. The presence of central sensitization and reduced conditioned pain modulation can make knee OA much harder to treat, however clinicians are now augmenting traditional physical therapy interventions with treatments like cognitive behavioral therapy and mind-body treatments that can influence how the central nervous system processes the pain signals. Unfortunately, those interventions do not influence the movement patterns used by people that can hasten joint degeneration including reduced knee motion and higher muscle co-contraction combined with buckling. These movements produce greater loads and higher shear forces in the knee that are particularly detrimental to articular cartilage. Recently physical therapy interventions have been developed to address the abnormal movement and muscle activation patterns but none have been shown to be any more effective than traditional aerobic or strengthening exercises. This may be due to deficits in the ability to learn new motor programs to stabilize the knee which is highly plausible considering that motor output and motor learning rely on accurate sensory feedback that we know is impaired in people with knee OA. This study will investigate the presence of central sensitization and reduced CPM and their influence on motor adaptation and learning in this population. The results will provide valuable insight into motor control that can be used to furthe develop treatments that will improve knee function while slowing progress of the disease.

 描述（由适用提供）：到2030年，据估计，在美国，有6700万人将患有骨关节炎（OA），大多数人将在中年开始时膝盖上有OA。患者在总膝盖替换之前忍受了多年的疼痛。膝盖OA患者忍受疼痛的年数会损害其膝盖功能和生活质量，但这也影响了神经系统处理疼痛信号的方式。疼痛的中心敏感性是对疼痛刺激的增强反应，这是一种受保护的机制，旨在使人体愈合。在正常情况下，当组织愈合完成时，中央灵敏度会消退。但是，有时中央灵敏度持续存在，疼痛被夸大或不再起源于外围源。这种异常的感觉处理可能导致诊断和治疗的不良结果，因为中枢神经系统中的疼痛来源不在周围组织中。膝盖OA患者已经证明了疼痛的中心敏感性，另一种异常疼痛机制使它加剧了：调节性疼痛调节（CPM）。 CPM涉及应用痛苦的“调理刺激”，从而减少了疼痛感知。中枢灵敏度和调节性疼痛调节的存在可能会使膝盖更难治疗，但是临床医生现在正在通过使用认知行为疗法和思维方式治疗的治疗方法来增强传统的物理治疗干预措施，这些治疗方法可以影响中枢神经系统处理疼痛信号。不幸的是，这些干预措施不会影响可以降低膝关节运动和较高肌肉共同收缩的人们使用的运动模式，并结合了屈曲。这些运动在膝盖中产生更大的载荷和较高的剪切力，这特别有害于关节软骨。最近，已经开发了物理治疗干预措施来解决异常运动和肌肉激活模式，但没有证明没有比传统的有氧运动或增强运动更有效。这可能是由于学习新的运动程序来稳定膝盖的能力而定义的，这是高度合理的 考虑到运动输出和运动学习取决于我们知道的精确感觉反馈，而膝盖OA患者会受到损害。这项研究将研究中央感官的存在和降低CPM及其对该人群中运动适应和学习的影响。结果将提供对运动控制的宝贵见解，可用于开发开发治疗，以改善膝盖功能，同时放缓疾病的进展。