Utility of MRS Brain Biomarkers of Pain Phenotypes after TBI
Abstract
Approximately 1.7 million people sustain a traumatic brain injury (TBI) in the United States each year according to the Centers for Disease Control and Prevention. More than 50% of people with TBI develop chronic pain conditions, decreasing long-term health-related quality of life and return to productive employment. Studies from other pain patient populations with chronic pain suggest that presence and severity of pain, emotional factors, and sensitivity to heat, pressure, and touch are associated with the brain chemistry and structure. If we can identify important changes in brain chemistry and structure after a TBI that are associated with chronic pain, so-called pain biomarkers, we will be able to understand more about the causes of pain and design treatments to target the specific causes of pain. The long-term goal of the proposed study is to develop a basis for treatments tailored to specific underlying causes and psychological contributors of TBI-related pain. This novel research will combine non-invasive, whole-brain imaging techniques that reveal brain chemistry and tissue structure suggestive of pain mechanisms with detailed assessments of pain symptoms, skin sensitivity, and neuropsychological assessments. The study will investigate areas of the brain that are significantly involved in the sensation and modulation of pain (i.e., the thalamus, insula, cingulate, prefrontal cortex, and hippocampus) and the associations with pain symptoms, skin sensitivity, and emotional factors. The proposed brain imaging is non-invasive, meaning that only standard MRI (magnetic resonance imaging) equipment is needed, and there are no injections of anything such as contrast agents, or chemical tracers. MRI is a safe and commonly used method of assessing the brain and other parts of the body. We plan to enroll both men and women, ages 18-50 with mild or moderate TBI (50 with chronic pain, and 50 with no chronic pain), at least 6 months after TBI, and 50 pain-free, non-injured people for comparison. The study will include two visits over 2-4 weeks, each visit lasting up to 4 hours. During these visits, we will collect information via interviews and tests regarding injury-related factors, pain, sensitivity to heat, pressure, and touch, psychosocial and neuropsychological assessments, and brain imaging. All visits will be at The Miami Project to Cure Paralysis, University of Miami (UM), except for the brain imaging, which will be performed at the Applebaum Diagnostic Imaging Center, also at UM. Biomarkers in people that reflect pain are directly useful for the understanding of chronic pain after TBI. For example, a pain biomarker can indicate a specific mechanism underlying the development and maintenance of a chronic pain condition and this mechanism can be targeted by a specific treatment. In addition, by measuring not just pain, but also neurological and emotional factors, we may uncover important contributors to the chronic pain conditions that help to guide combination approaches to pain management. Human pain biomarkers may also help basic researchers design new treatments for pain after TBI. Because persistent pain is one of the major contributors to suffering and decreased quality of life after TBI, the proposed research addresses important priority areas of the Department of Defense (DoD) and Department of Veterans Affairs (VA) with goals of reducing pain, increasing function, and improving the quality of life for active military, Veteran, and civilian populations who experience persistent pain after their TBI. Due to current and past international conflicts, there has been an increase in active military personnel and Veterans who have sustained a TBI. TBI often causes persistent pain that negatively impacts on quality of life and significantly interferes with common daily activities, including physical activities needed for general rehabilitation and conditioning. Thus, the results of the present st
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610114
Entities
People
- Eva Widerstrom-noga
Organizations
- United States Army
- University of Miami