Ethnic Differences in Acute Pain and Analgesic Response

描述(申请人提供)：疼痛是威胁美国的最昂贵和最普遍的公共卫生问题之一。虽然在疼痛及其治疗方面的种族差异已有报道，但种族对止痛药反应的影响很少受到关注。这项研究将使用一个常见的急性临床疼痛模型来识别和表征导致种族群体在疼痛感知和止痛方面存在差异的心理、生理和遗传因素。目的1将确定种族群体对急性术后疼痛的知觉和生理反应的差异，并研究这些差异与遗传、术前心理物理和心理社会因素的关系。目的2将确定阿片类药物镇痛和副作用的种族差异，并检查解释组内镇痛反应差异的遗传、药代动力学(PK)、药效学(PD)和心理社会因素。200名非洲裔美国人和白人成年人(年龄范围18-55岁)将参加这项研究，他们接受了第三磨牙拔除手术。我们将评估手术前的实验性疼痛反应和心理社会措施。我们将监测术后疼痛程度以及对阿片类芬太尼的PK和PD反应。我们将评估两组在术后疼痛以及术后数小时和术后3天内的止痛反应方面的差异。我的目标是建立一个基础，在此基础上建立一个与临床相关的实验性神经科学疼痛研究的独立研究生涯。拟议的培训和辅导性研究最终将加深我对导致健康差距的生物、心理和社会因素的理解。我提出了4个主要培训目标：1)发展心理物理和临床疼痛评估方面的专门知识，重点是种族差异；2)了解参与术后疼痛和止痛反应的复杂遗传、PK/PD过程；3)增加先进生物统计学方法方面的知识；4)提高对与种族差异有关的因素的理解。我的长期职业目标是发展一系列计划研究，旨在阐明生物、心理和社会因素对疼痛种族差异的影响。最终，我将从事转化研究，通过开发旨在提高疼痛患者生活质量的干预措施，与NINDS的战略计划保持一致，以减少临床疼痛方面的健康差距。

DESCRIPTION (provided by applicant): Pain is one of the most costly and pervasive public health problems threatening the Untied States. While ethnic disparities in pain and its treatment have been reported, the influence of ethnicity on responses to analgesics has received scant attention. This study will use a common acute clinical pain model to identify and characterize psychosocial, physiological and genetic factors that contribute to ethnic group differences in pain perception and analgesia. Aim 1 will determine ethnic group differences in perceptual and physiological responses to acute post-operative pain and to examine how those are related to genetic, pre-operative psychophysical and psychosocial factors. Aim 2 will determine ethnic differences in opioid analgesia and side effects and to examine genetic, pharmacokinetic (PK), pharmacodynamic (PD), and psychosocial factors that explain group differences in analgesic responses. 200 African American and white adults (age range 18-55) who undergo third molar extraction will be included in this study. We will assess preoperative experimental pain responses and psychosocial measures. We will monitor postoperative pain levels along with PK and PD responses to the opioid fentanyl. We will assess group differences in post-operative pain as well as analgesic responses immediately for several hours post surgery and up to 3 days post-procedure. My objectives are designed to establish a foundation upon which to build an independent research career in clinically-relevant experimental neuroscience pain research. The proposed training and mentored research will ultimately enhance my understanding of biopsychosocial factors that contribute to health disparities. I propose 4 main training objectives: 1) Develop expertise in psychophysical and clinical pain assessment with emphasis on ethnic differences; 2) Gain an understanding of the complex genetic, PK/PD processes involved in post-operative pain and analgesic responses; 3) Increase knowledge in advanced biostatistical methodology; and 4) Improve understanding of factors related to ethnic differences acute pain and analgesia. My long-term career goal is to develop a programmatic line of research designed to elucidate biopsychosocial contributions to ethnic differences in pain. Eventually, I would engage in translational research to reduce health disparities in clinical pain through the development of interventions designed to enhance the quality of life of individuals with pain, consistent with the strategic plan of NINDS.