Neural Correlates of Knee Sensorimotor Control in Patients With Patellofemoral Pain Syndrome
Condition: Patellofemoral Pain Syndrome; Patellofemoral Pain
MeSH terms: Patellofemoral Pain Syndrome; Syndrome; Somatoform Disorders
Study type: Interventional

Summary: 
      This study aims to determine the neural correlates of knee motor control in young females
      with patellofemoral pain (PFP). Each participant will attend a single study visit which may
      last up to 3 hours.
    

Detailed description: 
      Patellofemoral pain (PFP) is one of the most common reported knee conditions in adolescents
      and young adults. PFP can affect nearly 30% of young adults and most frequently affect those
      who participate in athletic activities involving running, jumping, and cutting. Pain during
      movement also adversely influences patellofemoral joint loading as evidenced by increased
      frontal and transverse plane hip motion during activities of daily living. While the
      biomechanical and anatomical components contributing to knee pain have been well established,
      the underlying neural mechanisms are less understood. For adults with chronic pain (e.g.,
      osteoarthritis), patients often exhibit greater 'pain network (e.g., anterior cingulate
      cortex, thalamus)' activation during sensory testing relative to healthy controls, possibly
      due to long term peripheral receptor activation resulting in hypersensitivity. Further,
      inducing pain (e.g., pressing on a thumbnail) results in similar neural activation of the
      pain network for those who have chronic pain symptoms.

      While these studies have been imperative to the understanding of pain on neural functioning,
      they are limited to those specific populations (e.g., fibromyalgia, osteoarthritis) and do
      not adequately replicate the pain experienced during daily activities. Traditional approaches
      consisting of bracing and physical therapy focused on strengthening the knee extensors have
      been unsuccessful in reducing pain. Further, interventions consisting of exercise therapy
      have not been effective for all patients with PFP, and other pain-reduction techniques, such
      as direct electrical stimulation of the motor cortex, have failed to produce improved motor
      function or long-lasting pain relief. The researchers of this study hypothesize that this is
      due to the failure to appropriately challenge the full sensorimotor network involved in
      processing sensory and cognitive stimuli for motor control. To effectively treat pain and
      manage this condition, the neural correlates of pain and sensorimotor knee control in those
      with PFP is needed.

      To appropriately assess the pain network for those with PFP, replicating knee and hip motion
      while neural function is measured is needed. The research team has successfully developed a
      combined knee and hip extension and flexion task that can be used safely with functional
      magnetic resonance imaging (fMRI). The researchers hypothesize that those with PFP will
      display depressed sensorimotor activity and increased pain network activity during the knee
      and hip flexion and extension task relative to previously collected data.

      The study visit will consist of one magnetic resonance imaging (MRI) session using a GE
      SIGNA™ Premier 3.0 Tesla MR scanner. The MRI portion of the study visit will be completed in
      75 minutes or less, and the entire visit will last up to 3 hours.
    

Intervention name(s): Neural Imaging
Intervention type(s): Other
Intervention description(s): During the acquisition of magnetic resonance (MR) images, the study participants will lie on the scanner table. For most portions of MR acquisition, the study participants will be instructed to lie still. For other parts of the acquisition, study participants will be asked to complete a combined knee and hip flexion/extension movement and a quadriceps contraction task in which they will be asked to 'squeeze' their quadriceps while keeping the rest of their body still. For the last 15 minutes of MR acquisition, the researcher will place one hand above the participants' knee and apply intermittent pressure to their quadriceps and medial aspect of the patella. Pain scales will be administered after every fMRI task to assess subjective perceptions of pain. Peripheral pulse oximetry and respiration waveforms will be collected for data analysis in order to minimize the potential confounding effect from the physiological changes.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science