Development of Co-Morbid PTSD and Chronic Pain Among Inner-City Women

 描述(申请人提供)：创伤后应激障碍和慢性疼痛非常普遍，每一种都与长期残疾和药物滥用有关，给个人和社会带来巨大的情感、功能和经济损失。创伤后应激障碍和慢性疼痛经常并存，重叠的比例在20%到70%之间，这是一个巨大的公共卫生问题。然而，我们对创伤后应激障碍和慢性疼痛相互交织的机制的了解有限。大多数关于创伤后应激障碍/慢性疼痛共同发病的研究是横断面的，集中在单一的慢性疼痛状况，限制了对其他慢性疼痛状况的因果推论和概括性。慢性疼痛也与药物滥用的高流行率有关。要了解与创伤相关的创伤后应激障碍以及复原力和脆弱性因素如何有助于从急性疼痛向慢性疼痛的过渡和药物滥用的发展，需要进行前瞻性设计。这样的研究对市中心的非裔美国女性至关重要，她们更有可能经历创伤性压力和疼痛，但不太可能得到适当的治疗；这种现象可能会导致更大的残疾和药物滥用风险。我们建议在一项为期6个月的前瞻性设计中，考察3个模型，这些模型与最初表现为急性疼痛(不是由创伤事件引起)的人的创伤后应激障碍/慢性疼痛配对和药物滥用的发展有关。首先是主要影响模型，在该模型中，基线的创伤后应激障碍症状水平将预测6个月后从急性疼痛过渡到慢性疼痛和发展成药物滥用的可能性。第二是缓和模型，在该模型中，基线脆弱性和弹性因素与创伤后应激障碍症状相互作用，以预测6个月后发展为慢性疼痛和药物滥用的可能性。第三是中介模型，在该模型中，创伤后应激障碍症状的基线水平与6个月后慢性疼痛和药物滥用的发展之间的关系是由3个月后的脆弱性和复原力因素调节的。内城妇女(N=600)到急诊科就诊，有急性身体疼痛症状，年龄18-40岁，将被招募。只有表现为急性盆腔/腹部、颈部/肩部或下背部疼痛且没有慢性疼痛病史的女性才会被登记。我们将评估3波(基线、3个月和6个月)的创伤暴露、创伤后应激障碍症状、疼痛敏感性、物质依赖和滥用、急性疼痛和心理社会韧性和脆弱性因素，并在1个月、2个月、4个月和5个月时获得额外的疼痛强度和干扰电话评估。之所以选择市中心的妇女，是因为她们暴露在持续的创伤事件中的可能性很高，而且有机会阐明特别是市中心少数族裔妇女中涉及创伤后应激障碍/慢性疼痛配对的健康差距。创伤后应激障碍、慢性疼痛和药物滥用并存带来的公共健康问题怎么强调都不为过，尤其是当它影响到美国的健康差距时。更好地了解创伤后应激障碍如何增加从急性疼痛过渡到慢性疼痛和发展为药物滥用的可能性，哪些因素导致这些发展，以及哪些人可能是最脆弱的，这将使我们能够对准确识别的目标进行更及时的临床干预，以帮助预防这些基本上难以治愈的疾病的发展。

 DESCRIPTION (provided by applicant): PTSD and chronic pain are highly prevalent and each is associated with long-term disability and substance abuse, exacting enormous emotional, functional, and financial tolls on individuals and society. PTSD and chronic pain are frequently co-morbid with overlap between 20% and 70%, representing an enormous public health problem. However, our understanding of the mechanisms by which PTSD and chronic pain become intertwined is limited. The majority of studies of the PTSD/chronic pain co-morbidity are cross- sectional, and focused on a single chronic pain condition, limiting causal inferences and generalizability to other chronic pain conditions. Chronic pain is also related to a high prevalence of substance abuse. To understand how trauma-related PTSD, and resilience and vulnerability factors contribute to the transition from acute to chronic pain and development of substance abuse requires prospective designs. Such research is vital among inner-city African American women, who are more likely to experience traumatic stress and pain, but are less likely to be treated appropriately; a phenomenon perhaps leading to greater risk for disability and substance abuse. We propose to examine 3 models related to the development of PTSD/chronic pain pairing and development of substance abuse in people initially presenting with acute pain (not caused by a traumatic event) in a 6-month prospective design. First is the Main Effects Model in which the level of PTSD symptoms at baseline will predict the likelihood of a transition from acute to chronic pain and development of substance abuse at 6 months. Second is the Moderation Model in which baseline vulnerability and resilience factors interact with PTSD symptoms to predict the likelihood of developing chronic pain and substance abuse 6 months later. Third is the Mediator Model in which relationships between baseline levels of PTSD symptoms and the development of chronic pain and substance abuse 6 months later are mediated by vulnerability and resilience factors at 3 months. Inner-city women (N=600) presenting to an Emergency Department with a complaint of acute bodily pain, ages 18-40 yrs, will be recruited. Only women presenting with acute pelvic/abdominal, neck/shoulder or low back pain, and who do not have a chronic pain history will be enrolled. We will assess trauma exposure, PTSD symptoms, pain sensitivity, substance dependence and abuse, acute pain and psychosocial resilience and vulnerability factors across 3 waves (baseline, 3- and 6-months), and obtain additional phone assessment of pain intensity and interference at 1-, 2-, 4-, and 5-months. Inner-city women were chosen because of their high likelihood of exposure to ongoing traumatic events and the opportunity to illuminate a health disparity involving the PTSD/chronic pain pairing among inner-city minority women in particular. The public health problem posed by co-morbid PTSD, chronic pain and substance abuse cannot be overstated, particularly as it impacts health disparities in the US. Greater understanding of how PTSD may increase the likelihood of transitioning from acute to chronic pain and developing substance abuse, which factors contribute to these developments, and which people may be most vulnerable will allow more timely clinical interventions on accurately identified targets to help forestall the development of these largely intractable conditions.