Catastrophizing and Cytokine Responses to Acute Pain in the Rheumatic Diseases

描述（由申请人提供）：疼痛性肌肉骨骼疾病影响数百万美国人，并与残疾和死亡等严重后果相关。越来越多的证据表明，疼痛的有害影响的一部分可能是由炎症介导的，疼痛和炎症过程参与了一个动态的，相互作用的关系，以及认知和情感因素密切参与疼痛的经验及其后果。目前的建议将提供必要的基础，建立一个临床研究计划，阐明的机制，心理社会过程，如疼痛相关的灾难性的关节炎，纤维肌痛，和其他疼痛的肌肉骨骼条件的疼痛相关的结果产生有害影响。灾难化已被确定为一组负面的认知和情感过程，以应对疼痛，并已与中央敏化，降低生活质量，并在风湿性疼痛的背景下增强疾病活动。该提案的PI拥有NIAMS指导职业发展奖，以研究类风湿性关节炎;本申请将提供必要的资源，以研究RA和其他风湿性疾病组中对急性疼痛的促炎免疫系统反应（以及灾难化对急性疼痛炎症反应的影响）。参与者将接受定量感觉测试，在此期间将给予疼痛的机械和冷刺激;神经内分泌的幅度和时间过程的个体和组差异（即，皮质醇）和促炎细胞因子（即，IL-6和TNF-1）对急性疼痛的反应。据我们所知，这将是第一个对照研究，以评估灾难化对急性伤害性刺激的炎症反应的影响，在多个样本的持续性疼痛患者。在慢性疼痛流行的背景下，进一步研究灾难化的作用机制变得越来越重要。流行病学研究已经确定灾难化是疼痛发展和持续的风险因素，减少疼痛相关灾难化是多学科疼痛治疗的重要目标。申请人对拟议项目的目标是了解灾难化影响疼痛相关结果的途径，以完善疼痛的生物心理社会模型，并促进对慢性肌肉骨骼疼痛的心理社会干预的增强。 公共卫生相关性：痛苦的肌肉骨骼疾病影响着数百万美国人，并与残疾和死亡等严重后果有关。越来越多的证据表明，疼痛的有害影响的一部分可能是由炎症介导的，疼痛和炎症过程参与了一个动态的，相互作用的关系，以及认知和情感因素密切参与疼痛的经验及其后果。流行病学研究已经确定灾难化是疼痛发展和持续的风险因素，减少疼痛相关灾难化是多学科疼痛治疗的重要目标。申请人对拟议项目的目标是了解灾难化影响疼痛相关结果的途径，以完善疼痛的生物心理社会模型，并促进对慢性肌肉骨骼疼痛的心理社会干预的增强。

DESCRIPTION (provided by applicant): Painful musculoskeletal diseases affect millions of Americans, and are associated with profound consequences such as disability and mortality. Increasing evidence suggests that part of the deleterious impact of pain may be mediated by inflammation, that pain and inflammatory processes engage in a dynamic, reciprocally-interacting relationship, and that cognitive and emotional factors are intimately involved in the experience of pain and its consequences. The present proposal will provide the necessary foundation to build a clinical research program elucidating the mechanisms by which psychosocial processes such as pain-related catastrophizing exert deleterious effects on pain-related outcomes in arthritis, fibromyalgia, and other painful musculoskeletal conditions. Catastrophizing has been identified as a set of negative cognitive and emotional processes in response to pain, and has been linked to central sensitization, reduced quality of life, and enhanced disease activity in the context of rheumatic pain. The PI for this proposal has a NIAMS Mentored Career Development Award to study rheumatoid arthritis; the present application would provide the necessary resources to investigate pro-inflammatory immune system responses to acute pain (and catastrophizing's impact on inflammatory responses to acute pain) not only in RA, but in other rheumatic disease groups as well. Participants will undergo sessions of quantitative sensory testing, during which painful mechanical and cold stimuli will be administered; individual and group differences in the magnitude and time course of neuroendocrine (i.e., cortisol) and pro-inflammatory cytokine (i.e., IL-6 and TNF-1) responses to acute pain will be studied. To our knowledge, this would be the first controlled study to evaluate catastrophizing's impact on inflammatory responses to acute noxious stimulation across multiple samples of patients with persistent pain. The need for further research into catastrophizing's mechanisms of action is increasingly important in the context of an epidemic of chronic pain. Epidemiological studies have identified catastrophizing as a risk factor for the development and persistence of pain, and reduction of pain-related catastrophizing represents an important goal for multidisciplinary pain treatment. The applicant's goal for the proposed project is to understand the pathways by which catastrophizing impacts pain-related outcomes in order to refine biopsychosocial models of pain and facilitate the enhancement of psychosocial interventions for chronic musculoskeletal pain. PUBLIC HEALTH RELEVANCE: Painful musculoskeletal diseases affect millions of Americans, and are associated with profound consequences such as disability and mortality. Increasing evidence suggests that part of the deleterious impact of pain may be mediated by inflammation, that pain and inflammatory processes engage in a dynamic, reciprocally-interacting relationship, and that cognitive and emotional factors are intimately involved in the experience of pain and its consequences. Epidemiological studies have identified catastrophizing as a risk factor for the development and persistence of pain, and reduction of pain-related catastrophizing represents an important goal for multidisciplinary pain treatment. The applicant's goal for the proposed project is to understand the pathways by which catastrophizing impacts pain-related outcomes in order to refine biopsychosocial models of pain and facilitate the enhancement of psychosocial interventions for chronic musculoskeletal pain.