Applying Biopsychosocial Model to Post-MVC Pain Development in African Americans

将生物心理社会模型应用于非裔美国人 MVC 后疼痛的发展

• 批准号: 8532639
• 负责人: SAMUEL A. MCLEAN
• 金额: $ 63.87万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8532639
• 关键词: Accident and Emergency department; Acute Pain; Adrenergic Agents; Affect; African American; Aftercare; American; Behavioral; Catecholamines; Chronic; Chronic neck pain; Cognitive; Constitutional; Data; Development; Discrimination; Disease; Enzymes; Equation; Etiology; European; Evaluation; Frequencies; Fright; Genetic; Genetic Predisposition to Disease; Genetic Variation; Home environment; Incidence; Individual; Injury; Interview; Knowledge; Mental Depression; Minor; Modeling; Musculoskeletal Pain; Neck Pain; Nervous system structure; Outcome; Pain; Participant; Pathogenesis; Perception; Persistent pain; Physiological; Process; Public Health; Recovery; Recruitment Activity; Reporting; Research; Research Personnel; Rheumatism; Role; Severities; Shapes; Site; Societies; Stress; Synapses; System; Testing; Vehicle crash; adrenergic; adverse outcome; biological adaptation to stress; biopsychosocial; chronic pain; cohort; disability; economic impact; ethnic discrimination; expectation; experience; follow-up; genetic variant; prospective; psychologic; response

DESCRIPTION (provided by applicant): Approximately 6 million Americans present to US Emergency Departments (ED) each year for care after motor vehicle collision (MVC). More than 90% of these individuals do not have serious physical injury and are discharged to home after ED evaluation. Persistent musculoskeletal pain develops in 10-20% of European Americans (EA) who experience such MVCs, with an economic impact of $29 billion per year in the US alone. The incidence of chronic pain development in African Americans (AA) experiencing MVC has never been reported. However, substantial evidence (and the investigator's pilot data) indicate that AA experience an increased burden of chronic pain. Reasons for this increased burden are poorly understood. Mechanisms of chronic musculoskeletal pain pathogenesis after MVC are described in biopsychosocial models, most notably Vlaeyen's fear-avoidance model (FAM), which is supported by substantial research. Experiences of discrimination may influence FAM processes and contribute to an increased incidence of chronic pain in AA experiencing MVC via a number of mechanisms. For example, discrimination experiences may: (1) cause stress-induced physiologic changes which increase initial pain in response to MVC, (2) increase subsequent depression and disability, and (3) increase chronic pain vulnerability in response to disability and depression. In addition, past adverse outcomes related to discrimination may increase negative expectations after MVC, which in turn may worsen pain-related outcomes. Available data suggest that the strength of an individual's ethnic identification may moderate these discrimination influences. To date, the FAM has never been evaluated in a cohort of AA transitioning to recovery vs. persistent pain, and the influence of discrimination and ethnic identity on FAM mechanisms has never been assessed. In addition, the influence of genetic vulnerability factors on FAM concepts and processes has rarely been evaluated, and never in AA. Evaluating genetic factors which influence the function of a physiologic system affecting FAM processes can advance our understanding of how constitutional factors interact with cognitive, psychological, and experiential factors to shape pain outcomes. The adrenergic nervous system is an excellent physiologic system to assess in this regard, because of its importance in pain perception, its critical role in the stress response, and its demonstrated interaction with FAM processes during chronic pain development. The proposed study will recruit one thousand AA presenting to a research network of ED sites after minor MVC. Participants will receive initial ED evaluation and follow-up interviews at 6 weeks and 6 and 12 months. Structural equation modeling will be used to test the multivariate predictive relationships described in the FAM. The influence of experiences of discrimination and ethnic identity on specific FAM concepts and processes will also be assessed, as will the influence of genetic factors affecting adrenergic system function. Together, the results of these analyses will substantially advance our knowledge of chronic pain pathogenesis in AA.

描述（由申请人提供）：每年大约有600万美国人向美国急诊部门（ED）出席机动车碰撞后的护理（MVC）。这些人中有90％以上没有严重的身体伤害，并且在评估后将出院。持续的肌肉骨骼疼痛发生在10-20％的欧洲人（EA）中，他们经历了此类MVC，仅在美国，每年的经济影响就会有29亿美元。从未报道过非洲裔美国人（AA）经历MVC的慢性疼痛发展的发生率。但是，大量证据（以及研究者的飞行员数据）表明，AA经历了慢性疼痛的负担增加。造成这种增加负担的原因知之甚少。 MVC后慢性肌肉骨骼疼痛发病机理的机制在生物心理社会模型中描述，最著名的是Vlaeyen的避免恐惧模型（FAM），这得到了大量研究的支持。歧视的经历可能会影响FAM过程，并导致通过多种机制经历MVC的慢性疼痛发病率增加。例如，歧视经历可能：（1）引起压力引起的生理变化，从而增加对MVC的初始疼痛，（2）增加随后的抑郁和残疾，以及（3）增加慢性疼痛因残疾和抑郁而增加慢性疼痛脆弱性。此外，与歧视有关的过去不良结果可能会增加MVC后的负面预期，而MVC又可能会使与疼痛有关的结果恶化。可用的数据表明，个人的种族认同的强度可能会减轻这些歧视影响。 迄今为止，从未在AA过渡到恢复与持续性疼痛的同类中进行评估，并且从未评估过歧视和种族认同对FAM机制的影响。此外，很少评估遗传脆弱性因素对FAM概念和过程的影响，而从未在AA中进行评估。评估影响人类过程的生理系统功能的遗传因素可以促进我们对宪法因素如何与认知，心理和经验因素相互作用以塑造疼痛结果的理解。肾上腺素能神经系统是在这方面进行评估的出色生理系统，因为它在疼痛感知中的重要性，其在压力反应中的关键作用以及在慢性疼痛发育过程中与FAM过程的相互作用。 拟议的研究将招募一千个AA，向次要MVC之后的ED站点研究网络呈现。参与者将在6周，6周和12个月的时间接受初步的ED评估和随访访谈。结构方程建模将用于测试FAM中描述的多元预测关系。还将评估歧视和种族认同体验对特定FAM概念和过程的影响，以及影响肾上腺素能系统功能的遗传因素的影响。总之，这些分析的结果将大大提高我们对AA慢性疼痛发病机理的了解。