Biopsychosocial influence on shoulder pain

描述(由申请人提供)：针对特定患者特征量身定做的治疗将对医疗保健的提供产生重大的积极影响。使用个体特征来有效地管理肌肉骨骼疼痛综合征特别耐人寻味，因为这些情况是普遍经历的，是社会的负担。从基础和临床前疼痛研究中获得的有希望的信息尚未转化为临床环境，以改善肌肉骨骼疼痛的管理。该R01奖将为一个多学科研究团队提供资源，以调查与疼痛相关的心理和遗传因素如何导致慢性肌肉骨骼疼痛的发展。我们的主要假设是，具有心理和遗传风险因素的受试者将更有可能表现出更高的实验性疼痛敏感性，导致a)运动引起的肩痛增加，b)术后慢性肩痛的发展。我们已经收集了有希望的初步数据，并将在两项独立的队列研究中研究我们的预测模型，这两项研究使用相同的心理和遗传标记，但疼痛模型不同。这一设计是创新的，因为它允许我们在受控环境下调查与慢性疼痛发展有关的机制，以及确定这些相同的风险因素是否对术后肩痛有临床意义的影响。这一系列研究的最终目标是根据患者的心理和基因构成提供个性化的肌肉骨骼疼痛管理。这项建议是这一过程中重要的第一步，因为我们将确定选定的心理和遗传风险因素是否能够早期和准确地识别慢性肩痛的发展。这一系列研究最终将使我们能够a)进行未来的随机试验，以确定基于心理和遗传风险特征的个性化治疗是否降低了发生慢性肩痛的可能性，以及b)在其他常见的肌肉骨骼疼痛状况(如背部和膝盖疼痛)中研究这一预测模型。 与公共卫生相关的慢性肩痛是一个普遍存在的社会问题。从基础和临床前研究中获得的有希望的信息尚未在临床环境中进行测试，以确定是否有可能及早和准确地识别可能发展为慢性肩痛的个人。这项研究的目的是调查是否可以使用心理和遗传风险因素来确定是否有可能发生慢性肩痛。

DESCRIPTION (provided by applicant): Treatment tailored to specific patient characteristics will have a significant positive impact on the delivery of healthcare. Using individual characteristics to effectively manage musculoskeletal pain syndromes is particularly intriguing because these conditions are commonly experienced and a burden to society. Promising information obtained from basic and pre-clinical pain research has not been translated into clinical settings to improve the management of musculoskeletal pain. This R01 Award will provide the resources for a multidisciplinary research team to investigate how pain-related psychological and genetic factors lead to the development of chronic musculoskeletal pain. Our primary hypothesis is that subjects with psychological and genetic risk factors will be more likely to exhibit elevated experimental pain sensitivity, resulting in a) increased exercise-induced shoulder pain and b) development of post-operative chronic shoulder pain. We have assembled promising preliminary data and will investigate our predictive model in two separate cohort studies that use the same psychological and genetic markers, but different pain models. This design is innovative because it allows us to investigate mechanisms involved with development of chronic pain in a controlled setting, as well as to determine whether these same risk factors have a clinically meaningful impact on post- operative shoulder pain. The ultimate goal of this line of research is to offer individualized musculoskeletal pain management based on a patient's psychological and genetic make up. This proposal represents an important first step in this process, as we will determine if the selected psychological and genetic risk factors allow for early and accurate identification of the development of chronic shoulder pain. This line of study will eventually allow us to a) conduct future randomized trials to determine if individualized treatment based on psychological and genetic risk profiles decreases the probability of developing chronic shoulder pain and b) study this predictive model in other commonly experienced musculoskeletal pain conditions (i.e. back and knee pain). PUBLIC HEALTH RELEVANCE Chronic shoulder pain is a prevalent and disabling problem for society. Promising information obtained from basic and pre-clinical studies has not been tested in clinical settings to determine if early and accurate identification of individuals likely to develop chronic shoulder pain is possible. The purpose of this study is to investigate whether psychological and genetic risk factors can be used to determine whether the development of chronic shoulder pain is likely to occur.