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慢性疼痛(Chronic Pain) 指疼痛持续超过3个月以上,已超出正常组织损伤修复时间范围,是一种独立的慢性疾病状态,而非仅仅是其他疾病的附属症状。其病理机制复杂,涉及外周痛觉调节紊乱、中枢敏化、情绪认知参与、炎症免疫通路异常等多因素互动,是美国最典型的大规模公共卫生问题之一。
最新研究进展
中枢敏化机制研究更深入:脑网络、脑区功能连接与疼痛记忆的长期可塑性成为新的解释框架,为表型分层与预后判断提供思路。
新型靶点药物开发推进:从传统阿片类管理转向非阿片机制,包括Nav1.7、TRPV1、CGPR通路、小胶质细胞抑制剂、炎性介质阻断等方向均在临床试验中推进。
神经调控和介入治疗发展迅速:脊髓刺激、外周神经调控、TMS/tDCS 等非侵入电调控逐渐进入标准路径探索。
AI、穿戴设备用于客观测量与实时管理:连续监测痛感、睡眠、活动量与心理压力成为患者长期管理的有力工具,有助于个体化治疗匹配。
跨学科综合管理概念强化:疼痛管理已经逐渐从“药物中心”走向“疼痛+心理+睡眠+运动”的多轴综合管理模式。目前仍待解决的核心临床痛点
缺乏稳定、客观、可广泛使用的生物标志物,临床仍以主观评分为主。
对复杂中枢敏化人群缺乏精准亚型分类与治疗匹配。
非阿片类创新药物在“真实临床结局改善”方面仍需更强证据。
高合并症(抑郁、焦虑、睡眠障碍)患者管理路径仍不够系统化。
可及性与长期管理不足,特别是基层医疗系统对慢性疼痛处置能力有限。
慢性疼痛的未来突破方向不再是寻找“一个更强的新止痛药”,而是建立基于生物学分层、神经网络调节、心理行为整合与长期数字化管理的综合机制治疗模式。
我们仅对美国国立卫生研究院(NIH)资助的在研相关项目进行梳理,希望给同仁们的选题思路提供一点启发。
2025年,以 "Chronic Pain"为检索词、在题目中进行检索,美国NIH针对慢性疼痛的在研有186项。
一,谁获得了这些研究?
1. 在研基金最多的PI:
ADAMS, MEREDITH C. B.,维克森林大学健康科学(WAKE FOREST UNIVERSITY HEALTH SCIENCES)
KAWI, JENNIFER,德克萨斯大学休斯顿健康科学中心(UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON)
VRANCEANU, ANA-MARIA,麻省总医院(MASSACHUSETTS GENERAL HOSPITAL)
2,基金最多的研究机构
WAKE FOREST UNIVERSITY HEALTH SCIENCES 维克森林大学健康科学中心
UNIVERSITY OF PENNSYLVANIA 宾夕法尼亚大学
UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON 德克萨斯大学休斯顿健康科学中心
UNIVERSITY OF WASHINGTON 华盛顿大学(西雅图)
MASSACHUSETTS GENERAL HOSPITAL 麻省总医院
二,研究热点
研究领域总览(根据关键词)
研究热点包括:神经病理性疼痛(Neuropathic Pain)、老年人(Older Adults)、大脑(Brain)、慢性疼痛治疗(Chronic Pain Treatment)、生活质量(Quality of Life)、阿片类药物使用障碍(Opioid Use Disorder)等。
三,借鉴与突破
我们也分享在美国该领域的几项课题摘要,希望对同仁们有所启发。
A,The Penn Human Precision Pain Center (HPPC): Discovery and Functional Evaluation of Human Primary Somatosensory Neuron Types at Normal and Chronic Pain Conditions
Migraine, one of the most common primary headache disorders, affects 1 in 4 US households. This complex neurologic disorder is mediated in part by alterations in trigeminal somatosensation, which manifests as head/fa- cial pain and/or trigeminal allodynia. Effective treatments for migraine are still limited, and our knowledge about human trigeminal system at baseline and migraine conditions are sparse. In response to RFA-NS-22-018, HEAL Initiative: Discovery and Functional Evaluation of Human Pain-associated Genes & Cells, we propose to form the Penn Human Precision Pain Center (Penn HPPC) to elucidate molecular, cellular, epigenetic, and physiological profiles of human trigeminal ganglion (TG) sensory neurons at baseline and migraine conditions. The Penn HPPC will be composed of Penn and international investigators with multidisciplinary expertise. The PI, two MPIs, and two co-Is are currently collaborating on a single-soma deep RNA-seq of human dorsal root ganglion (DRG) neuron project, which form a strong foundation for this application. Specifically, the Penn HPPC will contain three cores and perform three projects. The administrative core will serve as a sole organizational and administrative entity for the Penn HPPC. The human tissue core will function as the sole entity for procuring and storing human tissues and distributing human tissues among research projects. The data core will be the sole entity for storage, processing, and distribution of all data from the HPPC projects. In project 1, we will employ three complementary approaches, a laser capture microdissection based single-neuron-soma deep RNA-seq (a novel method developed by the PI’s lab, which has been successfully used with human DRG neu- rons), 10 x Visium (a commercially available spatial transcriptomics platform), and MERSCOPE (another com- mercially available spatial transcriptomics platform) to conduct single-soma RNA-seq of neurons and non-neu- ronal cells of TGs from control donors and those with migraine. In project 2, we will perform two types of single- nucleus multi-omics sequencing with TGs from control donors and those with migraine: chromatin accessibility (ATAC plus RNA, 10x Genomics multiome assay) and DNA methylation (methylation plus RNA, snmCAT-seq). In project 3, we will recruit migraine patients and control human subjects to conduct pain questionnaires, soma- tosensory tests, blink reflex, and in vivo microneurography recordings of trigeminal and spinal sensory afferents. Together, our proposed Penn HPPC will produce comprehensive and multi-dimensional datasets of human TGs at baseline and migraine conditions, which will generate unprecedent molecular, cellular, and functional atlas to understand normal trigeminal sensations and abnormal sensations associated with migraine. Our results may also lead to discovery of new biomarkers for migraine diagnosis and/or identification of novel potential drug targets for migraine treatment.
B, Personalized Auricular Point Acupressure for Chronic Pain Self-Management in Rural Populations
Despite a range of therapeutic approaches, chronic musculoskeletal pain (CMP) persists at a high rate, creating a public health burden. Our long-term goal is to increase access and scalability of evidence-based interventions while addressing pain care disparities for rural individuals with limited resources and/or endure long distances to specialty pain care. We will conduct a hybrid implementation-effectiveness trial, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework in diverse healthcare systems and communities across the United States in Texas and South Carolina focusing on rural health populations. Specifically, in our UG3 phase, we aim to plan and evaluate our Auricular Point Acupressure Self-Management (APA-SM) program integrated into rural health care and communities. Our team has accumulated extensive evidence supporting the use of APA-SM in decreasing pain intensity, reducing pain interference, and improving physical function. To maximize self-management of pain, we successfully developed and tested a smartphone APA app, an integral component of our APA-SM program, so patients can learn to self-administer APA. We also used ecological momentary assessment integrated into our app to measure real-world outcomes with participants able to self-monitor their progress using this as an innovative behavior change strategy. Our APA-SM program is theory-based according to Bandura’s self-efficacy model, toward successful initiation and maintenance of participants’ behavior change. In the UG3 phase, we will work with the NIH Pragmatic Trials Collaboratory Coordinating Center and collaborate extensively with our stakeholders to plan, implement, evaluate, and sustain our intervention. In the UH3 phase, using a pragmatic, randomized clinical trial, we will evaluate the clinical effectiveness of our 4-week APA-SM program. We will compare 3 groups: self-guided APA-SM, APA-SM + in-person training, and education control. The primary outcomes are pain intensity, pain interference, and function; the secondary outcomes are based on the HEAL Clinical Pain Core common data elements, and analgesic use, up to a 6-month follow-up. We will also evaluate implementation outcomes, cost-effectiveness, and predictive factors for APA-SM treatment response. A two-phase design in our UH3 will include an initiation (support for buy-in) and maintenance (no support provided) phase.
天下科研,唯快不破。
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作者:Amber Wang,助理:ChatGPT
美国Healsan(恒祥医学),专长于Healsan™医学大数据分析、基于大数据的HansonCR™临床科研支持,以及MedEditing™的医学编辑服务。主要为医院科研处、生物制药公司和医生科学家提供数据分析和SCI报告,成为诸多机构的“临床科研外挂”。
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