An in-depth Examination of the Psychological Processes involved in the Transition from Acute to Chronic Pain after a Traumatic Musculoskeletal Injury

深入研究创伤性肌肉骨骼损伤后从急性疼痛转变为慢性疼痛的心理过程

• 批准号: 10329969
• 负责人: Maria Lynn Pacella
• 金额: $ 12.33万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10329969
• 关键词: Accident and Emergency department; Acute; Acute Pain; Age; Agreement; Anxiety; Autonomic nervous system; Behavior; Behavioral; Belief; Biological Markers; Chronic; Clinical Trials Design; Cognition; Cognitive; Cognitive Therapy; Collection; Country; Data; Data Collection; Development; Devices; Distress; Ecological momentary assessment; Electronic Mail; Emergency department visit; Emotional; Emotions; Environment; Evolution; Fostering; Fright; Future; Goals; Heart Rate; High Prevalence; Hour; Individual; Injury; Interruption; Intervention; Intervention Trial; Measures; Mediating; Mental Depression; Mental disorders; Modeling; Monitor; Motorcycles; Movement; National Institute of Arthritis, and Musculoskeletal, and Skin Diseases; Numeric Rating Scale; Opioid; Pain; Pain intensity; Pain interference; Pain management; Patient Self-Report; Patients; Pattern; Persons; Phase; Physiological; Population; Prevention; Prevention strategy; Process; Prospective, cohort study; Psychological Factors; Reaction; Recording of previous events; Recovery; Reporting; Research; Research Activity; Research Personnel; Resolution; Rest; Risk; Risk Factors; Savings; Secondary pain; Severities; Stress; Surveys; Symptoms; System; Techniques; Text Messaging; Time; Training; Training Activity; Trauma; Trauma patient; United States; Universities; Vehicle crash; Work; anxiety sensitivity; biopsychosocial; biopsychosocial factor; career development; chronic pain; chronic pain management; coping; craving; data management; design; disability; disability-adjusted life years; emotional factor; fitbit; high risk; improved; indexing; injured; innovation; longitudinal, prospective study; multidisciplinary; multimodality; musculoskeletal injury; novel; opioid overuse; pain chronification; pain outcome; pain relief; pain score; patient oriented research; pharmacologic; point of injury; post-traumatic stress; prevent; programs; prospective; psychologic; recruit; response; secondary analysis; sensor; sex; skills; therapy design; treatment strategy; years of life lost

PROJECT SUMMARY/ABSTRACT Identifying modifiable biopsychosocial factors that can reduce the high proportion (>20%) of injured patients who transition from acute pain (AP) to chronic pain (CP) could reduce the burden and disability from this condition. Maladaptive cognitive-behavioral strategies (e.g., fear-avoidance beliefs; catastrophizing) and emotional factors (e.g., general distress) are consistently associated with post-injury pain, especially in patients with pre-injury psychological vulnerabilities. However, it is unknown whether these psychological processes are causal in the transition from post-injury AP to CP, and are thus a target for CP prevention. For this K01 proposal, I will conduct a prospective cohort study in 200 motor vehicle crash patients with musculoskeletal injury to determine the temporal associations between maladaptive psychological processes and the development of CP. Preliminary data support the feasibility of recruitment and retention, the use of electronic communication, and collection of longitudinal data among trauma patients. We aim to: 1. Examine the concurrent association of psychological and physiological (heart rate activity and 24-hour activity patterns) processes with average levels of injury-related pain intensity throughout 3-months post-injury; 2. Determine the time windows when specific maladaptive cognitive-behavioral and emotional processes appear during the transition from injury-related AP to CP; and 3. Assess the biopsychosocial moderators of the transition from injury-related AP to CP. We will intensively examine interactions of cognitive-behavioral and emotional factors from the point of injury (emergency department) to acute (< 4 weeks), subacute (≈ 4 to 12 weeks post-injury), and chronic (> 12 weeks post-injury) time periods. We will augment traditional retrospective self-report surveys with prospective ecological momentary assessment (EMA) via text messages and biomarkers of distress via Fitbit devices. This project will foster career development through hands-on training in: 1. The design and conduct of rigorous prospective research on the transition to CP/disability after musculoskeletal injury and on clinical trial design for secondary pain prevention; 2. The use of multimodal techniques to measure and monitor post-injury maladaptive psychological and physiological responses and pain-related processes; 3. The data management, analysis and interpretation of a prospective, longitudinal study with intensive data collection; and 4. Grantsmanship skills. These proposed research and training activities will capitalize on the multidisciplinary environment at the University of Pittsburgh to advance strategies for pain prevention. This goal is well-aligned with the NIAMS Long-Range Plan for FY 2015-2019 to use multidisciplinary, multilevel, and non-pharmacological approaches to prevent chronic pain (CP) in the injury population at large. This K01 application will help the PI launch an independent program of impactful patient- oriented research to become an independent investigator with expertise in: 1) the psychological contributors to CP, and 2) prevention efforts to reduce the burden of CP and improve recovery after acute physical injury.

项目总结/文摘