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Pathophysiology of Active and Latent Myofascial Trigger Points

Award Number: R21AT011778
ORGANIZATION: CENTER FOR DRUG EVALUATION AND RESEARCH, NIH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 05/01/2022
PERIOD OF PERFORMANCE END DATE: 12/31/2024

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Pathophysiology of Active and Latent Myofascial Trigger Points - PROJECT SUMMARY Pain deriving from a range of health concerns including headache, low back pain, osteoarthritis, carpal tunnel syndrome, as well as post-surgical and cancer pain have been linked to myofascial trigger points (TrPs). The TrP is a tender nodule along a taut band of muscle. Two states of the TrP are known to exist: active and latent. In the active state, the TrP is spontaneously painful and elicits pain referral mimicking the clinical complaint. The latent TrP is not spontaneously painful and any referred pain it elicits upon palpation is not related to a clinical pain complaint; the latent TrP is thought to be an intermediary state between healthy and an active TrP. Evidence from ultrasound indicates latent TrPs exhibit reduced blood flow, which is further reduced in active TrPs, suggestive of metabolic disruption and cellular stress. In line with that observation, hypothesized TrP models predict reduced glucose and elevated lactate in TrPs, however a pilot massage intervention trial that reduced active TrP pain found no change in glucose and an increase in lactate. The discrepancy between the TrP model and empirical evidence argues that cellular metabolism within a TrP may behave differently than the well-accepted model predicts. Lactate has also been linked to nociceptor sensitization, which could explain differences in local or referred pain experience. Furthermore, the differences in blood flow between latent and active TrPs could result in metabolic differences that may be informative as to the formation, progression, and perpetuation of TrPs. The present study will use a targeted and non-targeted metabolomics approach to understand the metabolic environment within both types of trigger points and healthy muscle. Latent TrPs from healthy individuals and active TrPs from individuals with tension-type headache will be investigated. The targeted approach will focus on glucose and lactate to determine whether carbohydrate energy balance is different within healthy muscle and trigger point sites. The non-targeted approach will screen for thousands of metabolic biomarkers within healthy muscle and the TrPs to identify relative differences in metabolites that could identify which metabolites lead to development of a latent TrP, progression to an active TrP, or perpetuation of the active TrP. The experiments described in this proposal will provide insight into the internal environment of TrPs. Should this exploratory study reveal disruption to carbohydrate energy balance or identify differences in biomarkers within latent or active TrPs a mechanism for the formation or progression of the TrP will become clear. This information could be used to optimize intervention techniques that will reverse or prevent muscle-derived pain. This proposed study will address the key goal to “Develop and validate biomarkers for chronic pain or other key symptoms to be used in studies of mind and body approaches” from the Funding Opportunity Announcement PA-18-322.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$8 )
2025	2023	THE REGENTS OF THE UNIVERSITY OF COLORADO	13001 E 17TH PL STE F428	AURORA	CO	80045	ADAMS	USA	Research and Training in Complementary and Integrative Health	000	2	4/22/2025	NON-COMPETING CONTINUATION	-$8
														Subtotal = -$8

Issue Date FY: 2023 ( Subtotal = $194,375 )
2023	2023	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Research and Training in Complementary and Integrative Health	000	2	4/11/2023	NON-COMPETING CONTINUATION	$194,375
														Subtotal = $194,375

Issue Date FY: 2022 ( Subtotal = $224,648 )
2022	2022	REGENTS OF THE UNIVERSITY OF COLORADO, THE	13001 E 17TH PLACE F428	AURORA	CO	80045	ADAMS	USA	Research and Training in Complementary and Integrative Health	000	1	4/29/2022	NEW	$224,648
														Subtotal = $224,648

Grand Total All Awards = $419,015

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Pathophysiology of Active and Latent Myofascial Trigger Points

Award Number: R21AT011778

ORGANIZATION: CENTER FOR DRUG EVALUATION AND RESEARCH, NIH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 05/01/2022

PERIOD OF PERFORMANCE END DATE: 12/31/2024

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