Development of Chronic Pain After Motor Vehicle Trauma

描述(由申请人提供)：塞缪尔·麦克莱恩博士，一名急诊内科医生，寻求从NIAMS获得以患者为导向的指导研究发展奖。为McLean博士的职业发展提出的项目调查了轻微机动车碰撞(MVC)后慢性疼痛的发展风险因素。每年有数以百万计的患者在美国急诊室接受轻微MVC后的治疗，MVC后的慢性疼痛和残疾(例如鞭打综合征)会导致巨大的社会成本。尽管如此，几乎没有二级预防措施可以防止这种结果，这主要是因为人们对这些疾病的病理生理学知之甚少，而且可用来确定高危人群的数据有限。这项计划建议研究教育署收集的简单评估措施，以预测受伤事件发生6个月后慢性疼痛的发展。拟议的研究计划包括一项对720名MVC后到ED就诊的患者的前瞻性纵向研究，并纳入了ED对先前已确定的慢性疼痛风险因素(如人口统计学和症状特征)和先前未被充分研究的神经生物学因素(如自主神经和下丘脑-垂体-肾上腺(“应激反应系统”)功能)的简要评估。越来越多的证据，包括飞行员收集的数据，表明这些神经生物学因素预测创伤后持续性疼痛和心理后遗症的发展。然而，这之前还没有被研究过。有效地识别慢性疼痛的高危患者，并更好地了解这些后遗症的病理生理学，对于制定成功的二级预防干预措施至关重要。麦克莱恩博士的职业发展活动建立在他之前协调基于ED的研究的经验和他两年的部分机构K12奖的基础上。他的研究活动发生在理想的导师和职业发展环境中，包括两个多学科研究中心：慢性疼痛和疲劳研究中心以及创伤、压力和焦虑研究中心。这项研究的目的是更好地理解为什么有些人在创伤事件后会出现慢性疼痛，而另一些人不会，以及为什么疼痛和创伤后应激障碍症状经常一起发展。我们希望利用这些信息制定成功的干预措施来预防这些疾病。

DESCRIPTION (provided by applicant): Dr. Samuel McLean, an Emergency Medicine Physician, seeks a Mentored Patient-oriented Research Development Award from NIAMS. The project proposed for Dr. McLean's career development examines risk factors for the development of chronic pain after minor motor vehicle collision (MVC). Millions of patients are treated in US EDs after minor MVC each year, and chronic pain and disability after MVC (e.g. whiplash syndrome) result in tremendous societal costs. Despite this, few if any secondary prevention measures are available to prevent this outcome, largely because the pathophysiology of these disorders is poorly understood and limited data are available to identify those at highest risk. This project proposes to examine the ability of brief assessment measures collected in the ED to predict the development of chronic pain 6 months after the injury event. The proposed research plan includes a prospective longitudinal study of 720 patients presenting to the ED after MVC, and incorporates a brief ED assessment of both previously identified chronic pain risk factors, such as demographic and symptom characteristics, and previously understudied neurobiological factors, such as autonomic and hypothalamicpituitary- adrenal ("stress response system") function. Converging evidence, including pilot data collected, suggests that these neurobiological factors predict the development of both persistent pain and psychological sequelae after trauma. However, this has not been previously studied. Effectively identifying patients at high risk of developing chronic pain and gaining a better understanding of the pathophysiology of these sequelae are crucial to the development of successful secondary prevention interventions. Dr. McLean's career development activities build upon his previous experience coordinating ED-based studies and upon his 2 year partial institutional K12 award. His research activities take place in an ideal environment for mentorship and career development, and include 2 multi-disciplinary research centers: the Chronic Pain and Fatigue Research Center and the Trauma, Stress, and Anxiety Research Center. The goal of this research is to better understand why some individuals develop chronic pain after a traumatic event and others do not, and why pain and posttraumatic stress disorder symptoms often develop together. We hope to use this information to develop successful interventions to prevent these illnesses.