Characterizing Extreme Phenotypes for Perceived Improvement From Treatment in Persons With Chronic Pain Following Traumatic Brain Injury: A NIDILRR and VA TBI Model Systems Collaborative Project.
Characterizing Extreme Phenotypes for Perceived Improvement From Treatment in Persons With Chronic Pain Following Traumatic Brain Injury: A NIDILRR and VA TBI Model Systems Collaborative Project.
复制标题
表征创伤性脑损伤后慢性疼痛患者治疗后感知改善的极端表型：NIDILRR 和 VA TBI 模型系统合作项目。
DOI：
10.1097/htr.0000000000000905
复制
发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Nakase-Richardson,Risa
中科院分区：
文献类型：
--
作者：
Hoffman,JeanneM;Ketchum,JessicaM;Agtarap,Stephanie;Dams-O'Connor,Kristen;Hammond,FloraM;Martin,AaronM;Sevigny,Mitch;Walker,WilliamC;Harrison-Felix,Cynthia;Zafonte,Ross;Nakase-Richardson,Risa
目的：根据创伤性脑损伤（TBI）后慢性疼痛患者疼痛的感知改善来定义和表征极端表型。地点：18个创伤性脑损伤模型系统（tims）中心。参与者：共有1762名tims参与者在受伤后1至30年的随访中报告慢性疼痛。主要测量：患者与疼痛治疗相关的整体变化印象（PGIC）。社会人口学、损伤、功能结局、疼痛和疼痛治疗特征。结果：参与者主要是男性（73%），白人（75%），中年人（平均46岁），在机动车事故中受伤（53%）或跌倒（20%）。极端改善表型（n= 512, 29.8%）被定义为PGIC“中度改善”或以上，极端无变化组（n= 290, 16.9%）被定义为没有变化或更差。最小绝对收缩和选择算子（LASSO）回归结合逻辑回归确定了改善与无变化极端表型的多变量预测因子。极端改善表型的高几率与女性（比值比[OR]= 1.85）、已婚与单身（OR= 2.02）、更好的运动功能（OR= 1.03）、更低的疼痛强度（OR= 0.78）和更少的疼痛，特别是胸痛（OR= 0.36）显著相关。与无改变表型相比，几种疼痛治疗与极端改善表型的更高几率相关，包括止痛药（OR= 1.85）、物理治疗（OR= 1.51）、瑜伽（OR= 1.61）、家庭锻炼计划（OR= 1.07）和按摩（OR= 1.69）。结论：基于疼痛治疗感知改善的极端表型研究强调了基于疼痛治疗反应性识别个体特征的能力。更好地了解那些对疼痛治疗有反应和无反应的人的生物心理社会特征可能有助于更好地监测、监测和治疗。随着进一步的研究，确定治疗反应/无反应的危险因素（如疼痛强度和频率）可能为TBI后慢性疼痛患者的护理提供指标。
Objective:To define and characterize extreme phenotypes based on perceived improvement in pain for persons with chronic pain following traumatic brain injury (TBI).Setting:Eighteen Traumatic Brain Injury Model System (TBIMS) Centers.Participants:A total of 1762 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most recent follow-up interview.Primary Measures:The Patient's Global Impression of Change (PGIC) related to pain treatment. Sociodemographic, injury, functional outcome, pain, and pain treatment characteristics.Results:Participants were mostly male (73%), White (75%), middle-aged (mean 46 years), injured in motor vehicle accidents (53%), or falls (20%). Extreme phenotypes were created for an extreme improvement phenotype (n= 512, 29.8%) defined as “moderately better” or above on the PGIC and an extreme no-change group (n= 290, 16.9%) defined as no change or worse. Least absolute shrinkage and selection operator (LASSO) regression combined with logistic regression identified multivariable predictors of improvement versus no-change extreme phenotypes. Higher odds of extreme improvement phenotype were significantly associated with being female (odds ratio [OR]= 1.85), married versus single (OR= 2.02), better motor function (OR= 1.03), lower pain intensity (OR= 0.78), and less frequent pain, especially chest pain (OR= 0.36). Several pain treatments were associated with higher odds of being in the extreme improvement versus no-change phenotypes including pain medication (OR= 1.85), physical therapy (OR= 1.51), yoga (OR= 1.61), home exercise program (OR= 1.07), and massage (OR= 1.69).Conclusion:Investigation of extreme phenotypes based on perceived improvement with pain treatment highlights the ability to identify characteristics of individuals based on pain treatment responsiveness. A better understanding of the biopsychosocial characteristics of those who respond and do not respond to pain treatments received may help inform better surveillance, monitoring, and treatment. With further research, the identification of risk factors (such as pain intensity and frequency) for treatment response/nonresponse may provide indicators to prompt changes in care for individuals with chronic pain after TBI.