Clinical Implications of Pain Phenotypes in Sickle Cell Disease

在这个建议中，我们的生物行为疼痛研究小组与约翰霍普金斯 成人SCD研究人员的医院团队，以解决令人难以置信的疼痛挑战 在SCD管理。尽管临床结果存在巨大的个体差异 在SCD患者中，几乎每天都有明显的疼痛， 目前对SCD中的疼痛表型以及这些表型如何影响 预测临床结果。我们的团队试图证明， 疼痛表型发生在SCD中，对疼痛的炎症/免疫反应有助于 这些疼痛表型预测了重要的临床结果 在SCD。我们提出了两个连续的研究：研究1将描述疼痛表型 使用情绪，个性和疼痛相关的灾难化措施和措施， 基于实验室的疼痛处理，包括疼痛敏感性和疼痛诱发 炎症/免疫反应。为了确定这些疼痛表型 是SCD特有的，实验室疼痛处理措施将在 非裔美国成年SCD患者和一组匹配的健康非裔美国人 成年人了为了确定临床效用和预测有效性的 在实验室中引起的炎症/免疫应答、炎症水平和 需要住院治疗的血管闭塞危象（VOC）期间的免疫反应将 在SCD患者中进行检查。研究2将确定疼痛表型 前瞻性预测SCD的临床结局。临床结果的测量将 包括平均每日疼痛、VOC频率和严重程度以及非计划性使用 疼痛管理的医疗保健。研究2中受试者的病历数据， 被送往约翰霍普金斯医院镰状细胞输注中心， 将检查VOC的管理，以确定阿片类药物的反应性。的能力 确定标准化的措施，如疼痛敏感性，疼痛诱发 炎症/免疫反应和心理社会因素，这有助于解释患者的 临床过程，特别是他们对阿片类药物治疗的反应，将有一个戏剧性的 影响医疗保健提供者如何处理这些患者的疼痛管理。

In this proposal, our team of biobehavioral pain researchers joins with the Johns Hopkins Hospital team of adult SCD researchers to address the incredible challenge of pain management in SCD. Despite tremendous individual differences in clinical outcomes among patients with SCD and the clear widespread experience of almost daily pain, very little is currently known about pain phenotypes in SCD and how these phenotypes predict clinical outcomes. Our team seeks to demonstrate that individual differences in pain phenotypes occur in SCD, that inflammatory/immune responses to pain contribute to these phenotypes, and that these pain phenotypes predict important clinical outcomes in SCD. We propose two sequential studies: Study 1 will characterize pain phenotypes using measures of mood, personality, and pain-related catastrophizing and measures of laboratory-based pain processing, including pain sensitivity and pain-evoked inflammatory/immune responses. In order to determine whether these pain phenotypes are specific to SCD, laboratory pain processing measures will be compared between African American adult SCD patients and a group of matched, healthy African American adults. In order to determine the clinical utility and predictive validity of the inflammatory/immune response elicited in the laboratory, level of inflammation and immune response during a vaso-occlusive crisis (VOC) requiring hospital care will be examined in the SCD patients. Study 2 will determine whether pain phenotypes prospectively predict clinical outcomes in SCD. Measures of clinical outcome will include average daily pain, frequency and severity of VOC, and unscheduled use of health care for pain management. Medical record data for participants in Study 2 who are admitted to the Johns Hopkins Hospital Sickle Cell Infusion Center for the management of VOC will be examined to determine opioid responsivity. The ability to identify standardized measures, such as pain sensitivity, pain-evoked inflammatory/immune responses, and psychosocial factors, that help explain patients' clinical course, and especially their responses to opioid therapy, will have a dramatic effect on how health care providers approach pain management in these patients.