Chronic Pain in Pediatric Primary Care

描述（由申请人提供）：在儿童和青少年时期，肌肉骨骼疼痛是主要的疼痛主诉，疼痛占初级保健预约的20-40%。儿童期疼痛很重要，因为它会增加成年后疼痛、残疾和精神疾病的风险。然而，儿童从急性疼痛过渡到慢性疼痛的机制尚不清楚。使用心理物理和心理评估的结合，本建议的中心目的是了解儿童和青少年从急性到慢性肌肉骨骼疼痛过渡的机制。该K23奖的长期目标是为候选人建立一个以患者为导向的研究项目，重点是识别高危青少年和预防慢性疼痛。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。候选人提出了一个五年的培训计划，在具有儿科疼痛、实验室疼痛评估和预防研究专业知识的教师导师的支持下，获得最先进的条理性疼痛调节评估、预防研究和初级保健疼痛评估、诊断和治疗培训的指导。华盛顿大学和西雅图儿童研究所为该奖项提供了优秀的机构支持和资源。研究计划包括三项研究。研究1将比较急性肌肉骨骼疼痛青年、慢性肌肉骨骼疼痛青年和健康无痛青年的临床表型。研究2将前瞻性地追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将试点一种基于网络的行为干预，用于初级保健慢性疼痛的早期治疗。这些研究将为未来的调查奠定基础，以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；数据可以告知慢性疼痛发展的预测模型。

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.