Translationalresearchin

rehabilitationmedicine:Whatwecanlearnfrombiomedicalresearch?

康復(fù)醫(yī)學(xué)中的轉(zhuǎn)化醫(yī)學(xué)研究

從生物醫(yī)學(xué)科研中的心得Dr.rer.biol.hum.BoyaNugraha,MSPostCongress-9thISPRM2015Hanover,25June2015ContentChronicpainsyndromes:epidemiologyandcharacteristics慢性疼痛特征Mechanismsofpainchronification(Fibromyalgiaasmodelofchronicpain)疼痛的慢性損傷肌肉纖維疼痛

?Neuroplasticity神經(jīng)重塑 ?Painmediators疼痛因子Conclusion

andFutureDirection

討論及未來展望Chronicpain(characteristicsandepidemiology)Paininmusculoskeletalsystemisveryfrequentsymptom: 肌肉骨骼系統(tǒng)疼痛為主

?withtissuedamage:e.g.Osteoarthritis,discherniation

實(shí)質(zhì)性損傷 ?without(specific)tissuedamage:jointdysfunction, irritationcausedbyoverstrain,muscle hypertensionandothers Manyofthesesyndromearenotverysevere(ordangerous)andselflimitingbutinsomecasestheycanbecomechronic Theimpactofmusculoskeletalpainonqualityoflife,andhealthexpensesisveryhighImportantquestion:howtoprevent(andtreat)chronicpainsyndromes

無特殊性損傷關(guān)節(jié)功能喪失

其中一些并不危險(xiǎn)，并且有自身受限，但某些情況下會變成慢性重要問題-如何預(yù)防并治療轉(zhuǎn)化成慢性疼痛Symptoms癥狀

Decreasedoverallpainthresholds ?increasedsensitivityofmusclesandtendonstopressure肌肉及肢體對壓力的敏感性增加Autonomousdysfunction

(Fibromyalgia) 自主神經(jīng)功能紊亂 ?sleepdisturbances, 睡眠終止

?fatigue疲勞 ?andothers其他Psycho-socialaspects ?highintensityofsuffering集中病痛感同身受

?strongfocusofattentiontosymptoms高度關(guān)注?highdemandforhealthinterventions高度健康關(guān)注CountryPrevalence(%)ReferenceUSA2.0Lawrenceetal.1998Canada3.3Whiteetal.1999Germany3.0Raspeetal.1992Poland4.5GaglieseandKatz.2000Spain2.4Carmonaetal.2001Italy2.2Salaffietal.2005Sweden2.5C?steretal.2008France1.6Perrotetal.2011Finland0.8M?kel?andHeliovaara,1991Denmark0.7Prescottetal.1993PrevalenceofFMSinseveralwesterncountriesMechanismsofpainchronificationMay,Pain2008;137:7–15DifferentlevelofplasticityinchronicpainNeuroplasticity:AlterationFunction功能Structure結(jié)構(gòu)Chemicalprofile化學(xué)指標(biāo)Centralsensitization

(CoghillRC2005)中樞patientwithchronicpain

慢性疼痛

normalsubject正常人Centralsensitization:functionalimagingGuedjetal.:JNuclMed2008;49:1798–1803May,2008May,2011.TheNeuroscientistChemicalprofile(painmediators)

化學(xué)剖面（疼痛因子）Painmediators:BrainDerivedNeurotropicFactor,BDNF

腦源性神經(jīng)營養(yǎng)因子CorrelationofBDNFandageinHealthyControlsandFMSpatientsPainmediators:BrainDerivedNeurotropicFactor,BDNFNugrahaetal.2013:NeurochemIntNugrahaetal.2012RheumatolIntPainmediators:BrainDerivedNeurotropicFactor,BDNF(ntotal=39;HADS-Dscore<8:n=21;8–10:n=10;>10:n=8;Dataareshowninmean±SEM;TheJocnkheere–Terpstratest:p<0.05)(ntotal=39;HADS-Ascore<8:n=9;8–10:n=12;>10:n=18;Dataareshowninmean±SEM;TheJocnkheere–Terpstratest:p>0.05).LevelofserumBDNFinFMSpatientsbasedondepressionscoregroupLevelofserumBDNFinFMSpatientsbasedonanxietyscoregroupCorrelation:R=0.434;p=0.006PainMediators:

CD3+CD56+NKTCells:FMSanddepression%CD3+CD56+NKTCellsHADS-DScoreR=-0.297;p=0.03ANOVA:p=0.02Post-hoc:Bonferronitest:HADS-D<8and>10(p=0.018)CorrelationNugrahaetal.2013ClinExpRheumPainmediators:Anandamide花生四烯酸乙醇胺Kaufmanetal.:Psychoneuroendocrinology2008;33,676–685Howtomanagechronicpain?如何處理慢性疼痛********ExerciseandbiomediatorsBiomediatorsEffectofExerciseHumanAnimalAnandamideIncreasedafterrunningandcycling(Sparlingetal.,2003;Raichelnetal.2012)Increasedafterrunning(Raichelnetal.2012)BDNFIncreasedBDNFmRNAinhippocampusvoluntaryrunningwheel(Neeperetal.,1995)SerotoninIncreseadinhumansIncreasedinrathippocampus(Bequetetal.,2008)CytokinesincreasedofIL-1?,IL-6andTNF-α(Ostrowskietal.,1999;Vassilakopoulosetal.,2003)ConclusionTranslationalresearchinrehabilitationmedicinecanhelpelucidatethepathomechanismsofdiseaseswhichcanbeusedtodiagnose,monitorthetreatment在康復(fù)中的轉(zhuǎn)化醫(yī)學(xué)研究可以幫助疾病的診斷及治療Morestudiesareneededtoinvestigatetheeffectivenessoftreatmentsinrehabilitionmedicinethroughbiomedicine通過生化方式研究康復(fù)醫(yī)學(xué)治療的影響有更多內(nèi)容需要進(jìn)行ThankyouBoyaNugraha,MS,PhDNugraha.Boya@mh-hannover.de

Dept.RehabilitationMedicine,HannoverMedicalSchoolHannover,GermanyENVIRONMENTALFACTORS,GENETICSPERIPHERALCENTRALHPA–AXIS:Cortisol,etcPAINImmunesystemandinflammatorymediators:cytokinesMuscledysfunctionMood-relateddisorderFatigueAninter-relatednetworkofFMSclinicalsymptomswithinflammatoryandmolecularmediatorsFibromyalgiaSyndrome.Nugrahaand