# Effects of Chronic Pain, Dyspnea, and Physical Activity Promotion on Functional Connectivity of the Brain in COPD

> **NIH VA I21** · VA BOSTON HEALTH CARE SYSTEM · 2021 · —

## Abstract

COPD is the nation's third leading cause of death and affects up to 11% of all VA healthcare patients.
Patients with COPD experience significant dyspnea despite optimization of medical therapy. In addition, over
half of patients with COPD experience chronic pain--largely musculoskeletal pain. Clinically, in patients who
suffer from both chronic pain and dyspnea, it is difficult to distinguish a patient's perception of one symptom
modulated by the other. Novel objective diagnostic tools are needed to complement patient self-report and
accurately distinguish symptoms in patients who have both chronic pain and dyspnea to optimize clinical
management. It is also important to study chronic pain and dyspnea in COPD because they are common
barriers to engaging in physical activity (PA) and exercise. The clinical course of COPD is characterized by a
downward spiral of dyspnea and chronic pain, physical inactivity, and significant functional limitation. Although
chronic pain and dyspnea can be barriers, PA and exercise are powerful, but underused, non-addictive
therapies for management of these symptoms in COPD. We developed Every Step Counts (ESC), a
technology-mediated intervention based on the Theory of Self-Regulation, to promote PA in COPD. We have
demonstrated ESC's safety, feasibility, and efficacy to increase PA and improve health-related quality of life in
Veterans with COPD. In two separate studies using questionnaires, ESC has been shown to improve dyspnea
in COPD and relieve chronic back pain in Veterans. An important next step is to understand the mechanisms
of benefit of PA interventions, like ESC, in the many COPD patients with both chronic musculoskeletal pain
and dyspnea to ultimately design better PA interventions and optimize treatment of these symptoms.
Currently, the central mechanisms of chronic pain and dyspnea, and how they change in response to PA
promotion in COPD are largely unknown. It has been shown that pre-stimulus resting state functional
connectivity determines pain perception in healthy humans. Resting state fcMRI evaluates interactions
between brain regions before a sensory event or when an explicit task is not being performed. These
communications are altered in older adults with chronic musculoskeletal pain. Functional connectivity among
regions specifically within the “default mode” network (DMN) (posterior cingulate, inferior parietal lobes, and
medial frontal gyrus) have been examined in clinical disease states, as this network is reliably detected and
well-characterized. Functional connectivity may be a novel biomarker of chronic pain and dyspnea. Aim 1:
Characterize and correlate the relationship between functional connectivity and chronic musculoskeletal pain
and dyspnea in 30 persons with COPD (10 with both symptoms, 10 with chronic pain, and 10 with dyspnea).
Aim 2: Explore changes in functional connectivity and changes in symptoms in 30 persons with COPD after
use of the ESC intervention to increase PA. Our pr...

## Key facts

- **NIH application ID:** 10120526
- **Project number:** 5I21RX003305-02
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Marilyn L. Moy
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10120526

## Citation

> US National Institutes of Health, RePORTER application 10120526, Effects of Chronic Pain, Dyspnea, and Physical Activity Promotion on Functional Connectivity of the Brain in COPD (5I21RX003305-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10120526. Licensed CC0.

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