Federico Pozzi

Research topics

Matched from this investigator's NIH project titles and abstracts.

• Pain and Nociception
• Developmental Cognitive Neuroscience

Active NIH awards

• Nervous system influences on recovery from painful rotator cuff tears

  5R01AR080058-03

  NIAMS · FY 2025 · $546K

  PROJECT SUMMARY In the last 30 years, clinical outcomes for individuals with rotator cuff tears have not substantially improved, which is problematic for the 4.5 million Americans that seek medical care for rotator cuff tears each year. Our long-term goal is to maximize functional recovery following rotator cuff tears by identifying patients most likely to benefit from targeted pain interventions. This knowledge is necessary to optimize treatments of impaired pain processing. Our central hypothesis is that the nervous system plays a larger role in symptom severity and recovery than conventionally believed. The rationale for this hypothesis is based on the disconnect between the rotator cuff structural damage and pain severity and the poor relationship between the extent of structural damage (i.e., tear size, retraction, etc.) and functional recovery. Dr. Pozzi, a physical therapist with expertise in biomechanics and movement science, will take his research in a new direction by approaching rotator cuff tears from pain and neuroscience perspectives. Dr. Pozzi assembled a team with extensive clinical, pain, neuroimaging, and pain-neuroscience expertise to test his central hypothesis through three specific aims: 1) test the association between brain function during a shoulder motor-task, chronicity of injury, and clinical pain symptoms in individuals with rotator cuff tears; 2) test the relationship between pain phenotypes, chronicity of injury, and clinical pain symptoms in individuals with rotator cuff tears; and 3) test the utility of baseline dispositional traits, quantitative sensory testing, and brain function to predict recovery following rotator cuff repair. This application is innovative because we will recruit the three injury etiologies of rotator cuff tears (traumatic- symptomatic, chronic-symptomatic, and asymptomatic), which provide a key advantage in studying chronic pain. We are uniquely positioned to shed light on how the nervous system reacts to sudden and chronic loss of tendon structural integrity with and without pain symptoms. We have the potential to test specific central features of acute rotator cuff-induced pain that may become chronic. We designed a novel experiment in which we will acquire functional brain images during precisely controlled submaximal isometric shoulder contractions. We will elucidate factors influencing movement-evoked pain of body areas associated with the primary clinical symptoms, thus providing evidence of potential intervention targets. Our study will provide a significant contribution by identifying additional factors that may influence the variability in patient outcomes. Further, our findings will move us toward the long-term goals of this line of investigation: informing precision pain medicine with consideration for specific pain phenotypes in individuals with rotator cuff tears. The knowledge gained in this study will not be incremental; it will springboard a paradigm shift in treating patients with rotator cuff tears.

• Blood flow restriction training for subacromial pain

  5R21AR082588-02

  NIAMS · FY 2025 · $153K

  PROJECT SUMMARY Subacromial pain, a generic term used to describe pain with disorders of structures within the subacromial space, is the most common reason for shoulder-related visits to primary care and has a high one-year prevalence. Patients with subacromial pain frequently complain of difficulty using the arm, impaired lifting, and limited exercise tolerance. Strengthening is a clinically relevant outcome in patients with subacromial pain. However, the high loads required for strengthening exacerbate pain and stress the rotator cuff tendons. Therefore, clinical practice guidelines recommend strengthening with low intensity and high frequency, but this combination often results in undertraining exercise prescriptions and lasting weakness. Blood flow restriction training (BFRT) is emerging as a novel adjunct treatment to address muscle weakness. It consists of strengthening exercises while an inflatable cuff restricts blood flow at the extremity. It is popular with athletes because it promotes muscle hypertrophy. It is also highly appealing as a rehabilitation strategy because it requires low external loads for strengthening. BFRT could have a tremendous positive impact on the recovery of patients with subacromial pain, but research is lacking. Our long-term goal is to conduct a large-scale efficacy trial of BFRT in patients with subacromial pain. As a critical step toward our long-term goal, this proposal is a pilot randomized trial to test trial procedures, safety and feasibility of the intervention, and preliminary efficacy of BFRT. Our pilot trial will be double masked (investigator & outcome assessor), include two parallel arms (active or sham BFRT), and two endpoints (after 16 BFRT sessions, primary endpoint; and after six months, secondary endpoint). This design is robust because it controls the non-specific effects of receiving BFRT (sham). The first aim tests recruitment, randomization, participant masking, retention, and data collection procedures. The second aim determine the safety and feasibility of the interventions (active BFRT and sham BFRT). The third aim describe the effect of active BFRT on clinical outcomes (shoulder strength, patient-reported outcomes, shoulder performance, muscle hypertrophy, and tendon thickness & elasticity). This application is innovative because: a) applies BFRT in a clinical population with subacromial pain; b) has clear objectives, analytic plans, and criteria to establish the success of the trial procedures, safety, and feasibility outcomes; and c) uses comprehensive outcomes to evaluate clinical recovery. The popularity of BFRT among professional athletes favors quick transitions to clinical applications even without support from high-quality research. Completing this preliminary trial will demonstrate that we have the capacity and capability to conduct and deliver a large-scale efficacy trial as planned. Collectively, this line of research will directly impact clinical practice.