Genetic and Environmental Origins of the Development of Pain in Children

项目摘要 儿科慢性疼痛是一个常见但未被研究的健康问题，患病率从 从童年到青春期，特别是在女孩中间。此外，在过去的时间里，患病率有所上升。 因为未知的原因被判20年。尽管它的高流行率和持久的影响，我们对它知之甚少 病因学和发育过程。文献记载了早期接触的关系 成人中的逆境和慢性疼痛，但对早期发育时间进程、关键 可减少青年风险的机制和社会复原力。需要解决的关键问题 在预防和干预的努力能够产生最大影响之前。为此，拟议的竞争 延续项目侧重于四个目标：确定遗传和环境对疼痛生长的影响 跨越童年和青春期(Aim1)；研究压力暴露在儿童精神疾病发展中的作用 儿童慢性疼痛(目标2)；评估压力和疼痛的两种潜在机制，以及 情绪调节(目标3)和表观遗传学(目标4)。在重新校准模型下，我们还探索了社交 青春期的恢复力作为这些风险过程的缓冲。为了实现我们的目标，我们建议进行 以出生记录为基础的密集纵向跟踪评估(14、15和16岁) 350对双胞胎的社区样本，他们的种族和社会经济地位不同。压力， 儿童早期和中期的情绪调节和反复疼痛已经很好了。 特色化的。青春期评估将采取多种方法，包括临床和 疼痛频率、强度、持续时间的日记评估；客观、日记和问卷评估 情绪调节、压力和社会韧性；以及对表观遗传学的客观评估。我们的基因 了解青少年疼痛的病因和机制的知情发展方法对于 确定良性慢性疼痛何时具有临床意义，并确定干预工作的关键目标 预防青少年慢性疼痛的发展并促进其康复。

Project Summary Pediatric chronic pain is a common but understudied health problem, with prevalence increasing from childhood to adolescence, particularly among girls. Moreover, prevalence rates have increased over the past 20 years for unknown reasons. Despite the high prevalence and enduring impact, we know little about its etiology and developmental progression. The literature documents associations between exposure to early adversity and chronic pain among adults, but little is known about the early developmental time course, key mechanisms, and social resilience that can mitigate risk in youth. Critical questions need to be addressed before efforts at prevention and intervention can have maximum impact. To that end, the proposed competing continuation project focuses on four aims: identify the genetic and environmental influences on growth in pain across childhood and adolescence (Aim1); examine the role of stress exposure in the development of children's chronic pain (Aim 2); and evaluate two potential mechanisms linking stress and pain, problems with emotion regulation (Aim 3), and epigenetics (Aim 4). Under a recalibration model, we also explore social resilience in adolescence as a buffer of these risk processes. To accomplish our aims, we propose to conduct intensive longitudinal follow-up assessments (at 14, 15, and 16 years of age) of a birth-records-based community sample of 350 pairs of twins who are diverse in ethnicity and socioeconomic status. Stress, emotion regulation, and recurring pain during early and middle childhood have already been well characterized. Assessments during adolescence will take a multi-method approach that includes clinical and diary assessments of pain frequency, intensity, duration; objective, diary, and questionnaire assessments of emotion regulation, stress, and social resilience; and objective assessments of epigenetics. Our genetically informed developmental approach to understanding the etiology and mechanisms of pain in youth is critical to determining when benign chronic pain is clinically significant and identifying key targets for intervention efforts to prevent the development of and promote recovery from chronic pain among youth.