Influence of PTSD Symptoms on Chronic Pain Development after Sexual Assault

PTSD 症状对性侵犯后慢性疼痛发展的影响

基本信息

批准号：
9349461
负责人：
SAMUEL A. MCLEAN
金额：
$ 66.68万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-17 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9349461
关键词：
Accident and Emergency department Acute Adrenal Glands Affect Caring Chronic Complex Consent Cross-Sectional Studies Data Development Dimensions Emergency Care Emergency Department Physician Emergency Situation Emergency department visit Enrollment Ensure Equation Etiology Evaluation Factor Analysis Genetic Genetic Variation Health Hypothalamic structure Individual Individual Differences Intervention Trial Link Mediating Methodology Modeling Musculoskeletal Pain Nurses Observational Study Outcome Pain Pain Measurement Participant Pilot Projects Pituitary Gland Population Post-Traumatic Stress Disorders Preventive Intervention Prospective Studies Prospective cohort study Recovery Reporting Research Personnel Study Section Subgroup Survivors Symptoms System Testing Time Training Trauma Veterans Woman assault chronic pain cohort common symptom design disaster survivor experience genetic variant high risk improved prevent prospective public health relevance sexual assault study population symptom cluster therapy development

项目摘要

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.

描述（由申请人提供）：每年有100,000多名美国妇女在性侵犯后寻求紧急医疗服务（SA）。初步紧急评估后，大多数妇女不会返回/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，可以识别SA幸存者进行预防性干预以改善恢复的机会。横断面研究表明，许多SA幸存者报道了慢性肌肉骨骼疼痛（MSP），并且与巨大的痛苦和健康状况不佳有关。但是，尚未对SA后评估慢性MSP结果的前瞻性研究，因此尚未建立SA和慢性MSP之间的牢固病因。在最近的一项前瞻性试点研究（n = 83）中，研究人员发现，有41％的女性SA幸存者招收的女性患有慢性中度或重度MSP。从所有接受试点研究参与的女性中收集的最初疼痛评分表明，有一半以上的慢性MSP同意和参与试点研究的疼痛评分。此外，收集的数据表明参加试点研究的女性SA幸存者是同一群SA幸存者，他们愿意参加预防性干预试验。但是，目前尚无有关影响从急性到慢性后SA MSP的过渡以告知此类试验设计的关键因素。可用证据表明，创伤后应激障碍（PTSD）症状可能是介导从急性到慢性后SA MSP的过渡的关键因素。已发现PTSD症状簇可以介导其他创伤人群中从急性到慢性MSP的过渡，研究人员的试验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 MSP发育的关键因素，但可用数据还表明，并非所有患有急性MSP的人都会出现PTSD症状，而并非所有患有PTSD症状的人都会出现慢性MSP。这表明重要的个体差异使这些关系降低了这些关系。可用的证据和研究者的试验数据表明，影响该遗传变异的遗传变异下丘脑 - 垂体 - 肾上腺（HPA）和儿茶酚胺能系统的功能构成了如此重要的个体差异。研究人员提出了一项对SA幸存者的前瞻性队列研究（N = 900），该研究评估了SA之后的1周，6周，6个月和12个月。一种方法论方法包括验证性因素分析和结构方程模型，将用于检验慢性MSP在研究人群中很常见的假设，即SA后PTSD症状簇介导了急性和慢性MSP之间的关系，并且所提出的遗传因素适度这些关系。这项开创性研究的结果将概括为大量的女性SA幸存者，这些妇女幸存者承受着慢性后SA MSP的负担，并将为这一研究的人群提供预防干预措施的发展。