Ethnic Differences in Acute Pain and Analgesic Response

描述（由申请人提供）：疼痛是威胁美国的最昂贵和普遍的公共卫生问题之一。虽然有关于疼痛及其治疗的种族差异的报道，但种族对镇痛药反应的影响却很少受到关注。本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不同种族在疼痛感知和镇痛方面差异的社会心理、生理和遗传因素。目的1将确定不同种族对急性术后疼痛的感知和生理反应的差异，并研究这些差异与遗传、术前心理物理和社会心理因素的关系。目的2将确定阿片类药物镇痛和副作用的种族差异，并检查解释镇痛反应群体差异的遗传、药代动力学（PK）、药效学（PD）和社会心理因素。200名接受第三磨牙拔牙的非裔美国人和白人成年人（年龄在18-55岁之间）将被纳入本研究。我们将评估术前实验性疼痛反应和心理社会措施。我们将监测术后疼痛水平以及对阿片类芬太尼的PK和PD反应。我们将评估各组术后疼痛的差异，以及术后几小时和术后3天内的镇痛反应。我的目标是建立一个基础，在此基础上建立一个独立的研究事业，在临床相关的实验神经科学疼痛研究。拟议的培训和指导研究将最终增强我对导致健康差异的生物心理社会因素的理解。我提出了4个主要的培训目标：1)培养心理物理和临床疼痛评估方面的专业知识，重点关注种族差异；2)了解术后疼痛和镇痛反应的复杂遗传、PK/PD过程；3)提高对先进生物统计方法的认识；4)提高对急性疼痛和镇痛的民族差异相关因素的认识。我的长期职业目标是发展一条程序化的研究路线，旨在阐明生物心理社会对疼痛的种族差异的贡献。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，减少临床疼痛的健康差异，与NINDS的战略计划保持一致。

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.