Chronic Pain in Pediatric Primary Care

描述(由申请人提供)：在儿童和青少年期间，疼痛占初级保健预约的20%-40%，肌肉骨骼疼痛是主要的疼痛主诉。儿童时期的疼痛是重要的，因为它增加了成年后疼痛、残疾和精神障碍的风险。然而，儿童从急性疼痛转变为慢性疼痛的潜在机制尚不清楚。利用心理物理和心理评估相结合的方法，这项建议的中心目标是了解儿童和青少年从急性肌肉骨骼疼痛向慢性肌肉骨骼疼痛过渡的机制。这个K23奖项的长期目标是让候选人建立一条以患者为导向的研究方案，专注于识别高危青年和预防慢性疼痛。这位K23候选人是华盛顿大学麻醉学和疼痛医学系的代理助理教授。候选人提出了一项为期五年的培训计划，并由在儿科疼痛、实验室疼痛评估和预防研究方面拥有专业知识的教师指导，以获得最先进的条件性疼痛调制评估、预防研究和初级保健疼痛评估、诊断和治疗方面的培训。华盛顿大学和西雅图儿童研究所为该奖项提供了极好的机构支持和资源。研究计划包括三项研究。研究1将比较患有急性肌肉骨骼疼痛、慢性肌肉骨骼疼痛的青年和健康的无疼痛青年的临床表型。研究2将前瞻性地跟踪初级保健中患有急性肌肉骨骼疼痛的青年样本，以确定慢性疼痛发展的预测因素。研究3将试验一种基于网络的行为干预，用于初级保健中慢性疼痛的早期治疗。这些研究将为未来的调查奠定基础，检查初级保健中有慢性疼痛风险的儿童的概况或临床表型；这些数据可以为慢性疼痛发展的预测模型提供信息。 公共卫生相关性：儿童和青少年的慢性肌肉骨骼疼痛与一系列负面后果有关，包括活动受限和心理社会功能不良。确定预测从急性肌肉骨骼疼痛向慢性肌肉骨骼疼痛过渡的心理物理因素将揭示能够使干预策略更有效地针对有慢性疼痛风险的儿童的机制。这项研究的长期目标是 该计划旨在预防儿童和青少年慢性疼痛的发展。

DESCRIPTION (provided by applicant): Pain accounts for 20-40% of primary care appointments during childhood and adolescence with musculoskeletal pain as a principal pain complaint. Pain in childhood is significant because it increases risk for pain, disability, and psychiatric disorders in adulthood. However, the mechanisms underlying the transition from acute to chronic pain in children are not known. Using a combination of psychophysical and psychological assessment, the central aim of this proposal is to understand the mechanisms that contribute to the transition from acute to chronic musculoskeletal pain in children and adolescents. The long-term goal of this K23 award is for the candidate to establish a programmatic line of patient-oriented research focused on identification of at- risk youth and prevention of chronic pain. The K23 candidate is an acting assistant professor in the Department of Anesthesiology and Pain Medicine at the University of Washington. The candidate proposes a five-year training plan with the support of faculty mentors who have expertise in pediatric pain, laboratory pain assessment, and prevention research to obtain instruction in state-of-the-art conditioned pain modulation assessment, prevention research, and training in pain assessment, diagnosis, and treatment in primary care. The University of Washington and Seattle Children's Research Institute provide excellent institutional support and resources for this award. The research plan involves three studies. Study 1 will compare clinical phenotypes of youth with acute musculoskeletal pain, chronic musculoskeletal pain, and healthy pain-free youth. Study 2 will prospectively follow a sample of youth with acute musculoskeletal pain in primary care to identify predictors of chronic pain development. Study 3 will pilot a web-based behavioral intervention for early treatment of chronic pain in primary care. These studies will lay the groundwork for future investigations examining profiles or clinical phenotypes of children in primary care who are at-risk for chronic pain; data that can inform a predictive model of chronic pain development. PUBLIC HEALTH RELEVANCE: Chronic musculoskeletal pain in children and adolescents is associated with a host of negative outcomes including activity limitations and poor psychosocial functioning. Identifying psychophysical factors that predict the transition from acute to chronic musculoskeletal pain will reveal mechanisms that can allow intervention strategies to be targeted more effectively to children at risk for chronic pain. The long-term goal of this research program is to prevent the development of chronic pain in children and adolescents.