Psychological and Neural Mechanisms of Pain Valuation

卫生保健服务的有效提供取决于人们是否有能力准确地评估 他们的痛苦，并在需要时立即就医。然而，实证研究已经确定了许多 人们系统性地低估他们的痛苦的例子--例如，经历心力衰竭的患者可能 在出现严重身体症状后延迟就医几个小时，通常是 致命的后果。拟议研究的目标是调查心理和神经方面的 评估疼痛的潜在机制，并解释为什么和如何发生评估失败。 行为和功能神经成像实验将调查(A)不同类型之间的关系 对疼痛的评估(例如，经历过的疼痛与记忆中的疼痛)；(B)个体之间的关系 疼痛评估的差异和负性情绪的性格差异，以及(C)神经通路 这在不同类型的疼痛评估对决策的影响中起中介作用。通过推进我们的 了解与疼痛相关的决策的心理和神经机制， 拟议的实验可能有助于改进临床环境中的疼痛测量并开发 提高患者疼痛相关决策质量的新型干预措施。 与公共健康相关：这项研究试图了解人们如何决定他们的痛苦的价值 在做出与疼痛相关的决定时。拟议的实验有可能解释为什么会这样 人们经常对疼痛做出错误的决定，例如，在以下情况下未能及时寻求医疗救治 经历严重的身体症状。通过揭示与疼痛相关的机制 决策，这项研究有可能改善临床环境中的疼痛测量，并 制定更有效的政策，以识别和治疗误报体检的高危个人 症状。 PHS 416-1(9/08修订版)第2页在整个表格第2页底部连续编号 应用程序。不要使用后缀，如2a、2b、 Kirschstein-NRSA个人奖学金申请者姓名(Lasf，前中首字母) 雅尔科尼，泰 (由申请人填写-按照小灵通416-1说明填写) 18.Kirschstein-NRSA奖学金培训和职业生涯的目标 我的长期目标是在认知-情感领域开发一个跨学科的研究计划 通过在一级研究中建立认知神经科学实验室来进行互动和决策 上大学。为了实现这一目标，我开发了我的NRSA奖学金申请，心中有三个目标。 首先，我将把我目前对经济决策的基础研究扩展到身体疼痛领域。 身体疼痛是一种生物上显著的、实验上可控制的信号，具有相当重要的临床意义， 从而为翻译研究情感和认知对决策的影响提供了理想的领域。 制作。我在这一领域的智力发展将极大地受益于Tor Wager博士在 关于疼痛的认知神经科学。第二，我的目标是获得使用最先进的多层次技术的专业知识 Wager博士的实验室目前正在开发功能磁共振成像分析的建模方法。这种方法提供了 对使用我的分析技术无法轻松解决的问题进行强大的调查 目前熟悉的。第三，我的目标是发展一种真正的跨学科视角来看待人类的决策 通过更好地理解行为学来补充我的认知神经科学背景 经济模型和技术。我在这方面的发展将得到埃尔克·韦伯博士的支持，他是 判断和决策领域的顶尖专家。 19.本授标项下计划的活动：在下文确定的活动中占拟议授标时间的大约百分比。(请参阅说明。) 一年制临床研究性课程工作教学 前90 10 第100秒 第100天 仅限博士前奖学金 四 这是 第五 仅限博士/博士奖学金 六分之一 H 简要解释研究以外的活动，并将它们与拟议的研究培训联系起来。 在我的第一年，我将注册或审计关于多元统计、疼痛和行为经济学的课程 旨在为我提供执行拟议实验所需的技能。 培训地点(S)初级培训地点是否与主办机构相同？是D否 如果不是，请在下面提供主要培训地点的详细信息 组织名称： 邓斯： Streeti：Street 2： 城市：县：州： 省：国家：邮政编码：

Efficient delivery of health care services depends on people's ability to accurately assess the severity of their pain and seek medical care promptly when it is needed. Yet empirical studies have identified many instances in which people systematically misvalue their pain-e.g., patients experiencing heart failure may delay seeking medical attention for several hours after the onset of severe physical symptoms, often with lethal consequences. The goal ofthe proposed research is to investigate the psychological and neural mechanisms underlying the valuation of pain and explain why and how failures of valuation occur. Behavioral and functional neuroimaging experiments will investigate (a) the relation between different types of valuation of pain (e.g., experienced versus remembered pain, (b) the relation between individual differences in pain valuation and dispositional differences in negative affect, and (c) the neural pathways that mediate the influence of different types of pain valuation on decision-making. By advancing our understanding ofthe psychological and neural mechanisms involved in pain-related decision-making, the proposed experiments can potentially help to improve measurement of pain in clinical settings and develop novel interventions to enhance the quality of patients' pain-related decisions. Public health relevance: This research seeks to understand how people determine the value of their pain when making pain-related decisions. The proposed experiments have the potential to explain why it is that people often make poor decisions about pain, e.g., failing to seek prompt medical attention when experiencing severe physical symptoms. By shedding light on the mechanisms involved in pain-related decision-making, the research has the potential to improve measurement of pain in clinical settings and to develop more effective policies for identifying and treating individuals at risk for misreporting of physical symptoms. PHS 416-1 (Rev, 9/08) Page 2 Number pages consecutively at the bottom throughout Form Page 2 the application. Do not use suffixes such as 2a, 2b, Kirschstein-NRSA Individual Fellowship Application NAME OF APPLICANT (Lasf, first middle initial) Yarkoni, Tai (To be completed by applicant- follow PHS 416-1 instructions) 18. GOALS FOR KIRSCHSTEIN-NRSA FELLOWSHIP TRAINING AND CAREER My long-term goal is to develop an interdisciplinary research program in the area of cognition-emotion interaction and decision-making by setting up a cognitive neuroscience laboratory at a first-tier research university. To achieve this goal, I have developed my NRSA fellowship application with three aims in mind. First, I will extend my present basic research on economic decision-making to the domain of physical pain. Physical pain is a biologically-salient, experimentally-controllable signal of considerable clinical importance, and thus presents ideal domain for translational research on emotional and cognitive influences on decision- making. My intellectual development in this area will benefit greatly from Dr. Tor Wager's expertise in the cognitive neuroscience of pain. Second, I aim to acquire expertise in the use of a state-of-the-art multilevel modeling approach to fMRI analysis currently being developed in Dr. Wager's lab. This approach affords powerful investigation of questions that cannot be easily addressed using the analyses techniques I am currently familiar with. Third, I aim to develop a truly interdisciplinary perspective on human decision-making by supplementing my background in cognitive neuroscience with a better understanding of behavioral economic models and techniques. My development in this area will be supported by Dr. Elke Weber, a leading expert in the area of judgment and decision-making. 19. ACTIVITIES PLANNED UNDER THIS AWARD: Approximate percentage of proposed award time In activities identified below. (See instructions.) Year Research Course Work Teaching Clinical First 90 10 Sec 100 Thir 100 PREDOCTORAL FELLOWSHIPS ONLY Four th Fifth MD/PhD FELLOWSHIPS ONLY Sixt h Briefly explain activities other than research and relate them to the proposed research training. In my first year, I will enroll in or audit classes on multivariate statistics, pain, and behavioral economics intended to provide me with the skills needed to carry out the proposed experiments. 20, TRAINING SITE(S) Is the Primary Training Site the same as the Sponsoring Institution? Yes D No If No, provide detailed information below for the Primary Training Site Location Organizational Name: DUNS: Streeti: street 2: City: County: state: Province: Country: Zip/Postal Code: