An in-depth examination of the psychological processes involved in the transition from acute to chronic pain after a traumatic musculoskeletal injury

项目摘要/摘要 确定可改变的生物、心理和社会因素，以降低受伤患者的高比例(&gt；20%) 从急性疼痛(AP)到慢性疼痛(CP)的过渡可以减轻这种情况下的负担和残疾。 不适应的认知-行为策略(例如，恐惧回避信念；糟糕的应对)和情绪因素 (例如，全身痛苦)始终与受伤后疼痛有关，尤其是在受伤前的患者 心理上的弱点。然而，目前尚不清楚这些心理过程是否在 从损伤后的AP过渡到CP，因此是CP预防的目标。对于这份K01提案，我将进行 180例车祸合并肌肉骨骼损伤患者的前瞻性队列研究 适应不良心理过程与慢性阻塞性肺疾病发展的时间关联。初步 数据支持征聘和保留、使用电子通信和收集 创伤患者的纵向数据。我们的目标是：1.考察心理和心理的同时关联 生理过程(心率活动和24小时活动模式)以及与损伤相关的平均水平 伤后3个月的疼痛强度；2.确定具体适应不良的时间窗口 损伤相关性AP向CP过渡过程中存在认知-行为和情绪过程； 评估从损伤相关性AP向CP转变的生物、心理和社会调节因素。我们将深入研究 从损伤点(急诊科)到伤情的认知-行为和情绪因素的相互作用 急性(&lt；4周)、亚急性(≈受伤后4至12周)和慢性(&gt；12周)时间段。 我们将用前瞻性的生态瞬时评估来补充传统的回溯性自我报告调查 (EMA)通过短信和Fitbit设备的遇险生物标志物。该项目将促进职业发展。 通过实际操作培训：1.设计和进行严格的前瞻性研究，以过渡到 肌肉骨骼损伤后的CP/残疾和二级疼痛预防的临床试验设计；2.使用 测量和监测损伤后适应不良心理和生理的多通道技术 反应和疼痛相关过程；3.前瞻性的数据管理、分析和解释， 纵向研究和密集的数据收集；4.精湛的技能。这些建议的研究和 培训活动将利用匹兹堡大学的多学科环境来推进 预防疼痛的策略。这一目标与NIAMS 2015-2019财年长期计划保持良好一致，以 使用多学科、多层次和非药理学方法预防损伤中的慢性疼痛(CP) 广大的人口。这个K01应用程序将帮助PI启动一个独立的有影响力的患者计划- 以研究为导向成为具有以下专长的独立调查者：1)心理贡献者 2)预防措施，减轻CP的负担，提高急性身体损伤后的恢复。

PROJECT SUMMARY/ABSTRACT Identifying modifiable biopsychosocial factors that can reduce the high proportion (>20%) of injured patients who transition from acute pain (AP) to chronic pain (CP) could reduce the burden and disability from this condition. Maladaptive cognitive-behavioral strategies (e.g., fear-avoidance beliefs; poor coping) and emotional factors (e.g., general distress) are consistently associated with post-injury pain, especially in patients with pre-injury psychological vulnerabilities. However, it is unknown whether these psychological processes are causal in the transition from post-injury AP to CP, and are thus a target for CP prevention. For this K01 proposal, I will conduct a prospective cohort study in 180 motor vehicle crash patients with musculoskeletal injury to determine the temporal associations between maladaptive psychological processes and the development of CP. Preliminary data support the feasibility of recruitment and retention, the use of electronic communication, and collection of longitudinal data among trauma patients. We aim to: 1. Examine the concurrent association of psychological and physiological (heart rate activity and 24-hour activity patterns) processes with average levels of injury-related pain intensity throughout 3-months post-injury; 2. Determine the time windows when specific maladaptive cognitive-behavioral and emotional processes appear during the transition from injury-related AP to CP; and 3. Assess the biopsychosocial moderators of the transition from injury-related AP to CP. We will intensively examine interactions of cognitive-behavioral and emotional factors from the point of injury (emergency department) to acute (< 4 weeks), subacute (≈ 4 to 12 weeks post-injury), and chronic (> 12 weeks post-injury) time periods. We will augment traditional retrospective self-report surveys with prospective ecological momentary assessment (EMA) via text messages and biomarkers of distress via Fitbit devices. This project will foster career development through hands-on training in: 1. The design and conduct of rigorous prospective research on the transition to CP/disability after musculoskeletal injury and on clinical trial design for secondary pain prevention; 2. The use of multimodal techniques to measure and monitor post-injury maladaptive psychological and physiological responses and pain-related processes; 3. The data management, analysis and interpretation of a prospective, longitudinal study with intensive data collection; and 4. Grantsmanship skills. These proposed research and training activities will capitalize on the multidisciplinary environment at the University of Pittsburgh to advance strategies for pain prevention. This goal is well-aligned with the NIAMS Long-Range Plan for FY 2015-2019 to use multidisciplinary, multilevel, and non-pharmacological approaches to prevent chronic pain (CP) in the injury population at large. This K01 application will help the PI launch an independent program of impactful patient- oriented research to become an independent investigator with expertise in: 1) the psychological contributors to CP, and 2) prevention efforts to reduce the burden of CP and improve recovery after acute physical injury.