Influence of PTSD Symptoms on Chronic Pain Development after Sexual Assault

描述（由申请人提供）：每年有超过10万名美国妇女在性侵犯后寻求紧急医疗护理（SA）。大多数妇女在最初的紧急评估后不返回/接受与SA有关的进一步护理。因此，紧急护理访问是一个独特的机会，以确定SA幸存者的预防性干预措施，以改善恢复。横断面研究表明，许多SA幸存者报告慢性肌肉骨骼疼痛（MSP），并与大量的痛苦和不良的健康结果。然而，没有前瞻性研究评估SA后的慢性MSP结局，因此SA和慢性MSP之间的病因联系尚未建立。在最近的一项前瞻性试点研究（n = 83）中，研究人员发现，41%的女性SA幸存者登记发展为慢性中度或重度MSP。从参与试点研究的所有女性中收集的初始疼痛评分显示，超过一半的慢性MSP高风险患者同意并参加了试点研究。此外，收集的数据表明， 参与试点研究的SA女性幸存者与愿意参与预防性干预试验的SA幸存者是同一组。然而，目前没有关于影响SA后MSP从急性向慢性转变的关键因素的信息，以告知此类试验的设计。现有证据表明，创伤后应激障碍（PTSD）症状可能是介导从急性到慢性SA后MSP过渡的关键因素。在其他创伤人群中，已经发现PTSD症状群介导了从急性到慢性MSP的转变，研究者的试点数据支持研究人群中的这些关系。重要的是，尽管有证据表明PTSD症状是介导慢性SA后MSP发展的关键因素，但现有数据还表明，并非所有急性MSP患者都会发展PTSD症状，也并非所有PTSD症状患者都会发展慢性MSP。这表明重要的个体差异调节了这些关系。现有的证据和研究人员的试点数据表明，遗传变异影响 下丘脑-垂体-肾上腺（HPA）和儿茶酚胺能系统的功能构成了这种重要的个体差异。研究人员提出了一项前瞻性队列研究，对SA后1周、6周、6个月和12个月的女性SA幸存者（n = 900）进行评估。一种方法学的方法，包括实证因素分析和结构方程模型将被用来测试的假设，慢性MSP是常见的研究人群中，创伤后应激障碍症状群介导SA后急性和慢性MSP之间的关系，以及建议的遗传因素缓和这些关系。这项开创性研究的结果将推广到大量女性SA幸存者，他们经历了慢性SA后MSP的高负担，并将为这一研究不足的人群制定预防干预措施提供信息。

DESCRIPTION (provided by applicant): Each year more than 100,000 US women seek emergency medical care after sexual assault (SA). Most women do not return for/receive further care related to SA after initial emergency evaluation. Thus the emergency care visit represents a unique opportunity to identify SA survivors for preventive interventions to improve recovery. Cross-sectional studies indicate that chronic musculoskeletal pain (MSP) is reported by many SA survivors and is associated with substantial suffering and poor health outcomes. However, no prospective studies evaluating chronic MSP outcomes after SA have been performed, and therefore a firm etiologic link between SA and chronic MSP has not been established. In a recent prospective pilot study (n = 83), the investigators found that 41% of women SA survivors enrolled developed chronic moderate or severe MSP. Initial pain scores collected from all women approached for pilot study participation showed that more than half of those at high risk of chronic MSP consented and enrolled in the pilot study. In addition, data collected indicate that women SA survivors who participated in the pilot study are the same group of SA survivors who would be willing to participate in preventive intervention trials. However, currently no informatio exists regarding key factors that influence the transition from acute to chronic post-SA MSP to inform the design of such trials. Available evidence suggests that posttraumatic stress disorder (PTSD) symptoms may be key factors mediating the transition from acute to chronic post-SA MSP. PTSD symptom clusters have been found to mediate the transition from acute to chronic MSP in other trauma populations, and the investigator's pilot data support these relationships in the study population. Importantly, despite evidence that PTSD symptoms are key factors mediating chronic post-SA MSP development, available data also indicate that not all individuals with acute MSP develop PTSD symptoms, and not all individuals with PTSD symptoms develop chronic MSP. This suggests that important individual differences moderate these relationships. Available evidence, and the investigator's pilot data, suggests that genetic variants affecting the function of hypothalamic-pituitary-adrenal (HPA) and catecholaminergic systems constitute such important individual differences. The investigators propose a prospective cohort study of women SA survivors (n = 900) evaluated 1 week, 6 weeks, 6 months, and 12 months after SA. A methodological approach including Confirmatory Factor Analyses and Structural Equation Modeling will be used to test the hypotheses that chronic MSP is common in the study population, that PTSD symptom clusters mediate the relationship between acute and chronic MSP after SA, and that the proposed genetic factors moderate these relationships. Results of this groundbreaking study will generalize to a large population of women SA survivors who experience a high burden of chronic post-SA MSP, and will inform the development of preventive interventions for this understudied population.