Identifying risk for transition from acute to chronic musculoskeletal pain in youth

项目总结 肌肉骨骼(MSK)疼痛影响了18%-32%的年轻人，并给儿童、家庭、 和医疗保健系统。在儿童时期，MSK疼痛的患病率随着年龄的增长而增加， 青少年的风险最高。当MSK疼痛变得慢性时，年轻人会经历重大的心理社会 困难、身体残疾和学校功能受损。儿科慢性疼痛的治疗费用是 据估计，美国每年的收入为190亿美元。迫切需要降低成本和影响 儿童慢性MSK疼痛，尤其是 vt.给出 那 疼痛、残疾和高卫生保健使用的风险可能 从青春期延伸到成年期。关键的第一步是确定过渡背后的机制 从急性到慢性的青少年MSK疼痛。一个被认为是慢性疼痛的关键机制是敏化 中枢痛觉通路和条件性痛觉调制中的损伤。研究表明疼痛程度不同 与健康样本相比，患有慢性疼痛的儿童和成人的调制，以及较差的疼痛抑制 预测成人未来慢性疼痛的风险。知识中的一个关键差距是疼痛调制、心理社会 因素和行为脆弱性增加了青少年从急性MSK疼痛向慢性MSK疼痛过渡的风险。AS 在NIH的联邦疼痛战略研究报告中概述，评估 剧集 预期 个人 急性期的疼痛过程 慢性疼痛状态是研究的重中之重。需要 研究从急性疼痛到慢性疼痛的过渡，以确定过渡机制和 冒着最大的风险。 此外，该报告强调了紧迫的 为了填补这些重要的知识空白，我们提出了第一个大规模纵向 对患有急性MSK疼痛的年轻人(n=300)进行队列研究，以测试从 从急性到慢性疼痛。青年将在一年内完成4个数据波的评估，并使用 结合：a)疼痛调制的定量感觉测试b)心理社会评估，以及c) 对睡眠的动态监测，中心目标是确定从急性到慢性转变的机制 MSK疼痛。我们还将描述睡眠不足、认知-情感脆弱性、 父母对疼痛的具体反应，以及儿童患疼痛风险的关键人口统计学特征 结果。这项创新研究的目的是解决目前儿科MSK疼痛研究中的一个主要差距 告诉我们疼痛是如何从急性状态转变为慢性状态的，并将提供知识 慢性MSK疼痛的早期危险因素。此提案生成的数据还将直接向您提供 我们的团队制定了针对青年的筛查方案和有针对性的预防干预措施 发生慢性MSK疼痛的最大风险。与联邦疼痛战略研究的目标保持一致 报告说，通过这项研究，我们将重点从治疗慢性疼痛转移到通过早期预防 识别高危青年。

PROJECT SUMMARY Musculoskeletal (MSK) pain affects 18-32% of youth and places a high level of burden on children, families, and the health care system. During childhood, prevalence of MSK pain increases with age, placing adolescents at highest risk. When MSK pain becomes chronic, youth experience significant psychosocial difficulties, physical disability, and impaired school functioning. Treatment costs of pediatric chronic pain are estimated at $19 billion annually in the United States. There is an urgent need to reduce the costs and impact of pediatric chronic MSK pain, particularly given that risk for pain, disability, and high health care use can extend from adolescence into adulthood. A key first step is identifying mechanisms underlying the transition from acute to chronic MSK pain in youth. A pivotal mechanism thought to underlie chronic pain is sensitization of central pain pathways and impairment in conditioned pain modulation. Research shows differences in pain modulation in children and adults with chronic pain compared to healthy samples, and that poor pain inhibition predictsrisk for future chronic painin adults. A critical gap in knowledge is how pain modulation, psychosocial factors and behavioral vulnerabilities confer risk for the transition from acute to chronic MSK pain in youth. As outlined in the NIH's Federal Pain Strategy Research Report, evaluating episode prospective individuals the course of pain from an acute to a chronic pain state is a top research priority. need for studies examining the transition from acute to chronic pain to identify transition mechanisms and at greatest risk. Further, the report highlights the urgent To fill these important knowledge gaps, we propose the first large-scale longitudinal cohort study of youth with acute MSK pain (n=300) to test a biopsychosocial model of risk for transition from acute to chronic pain. Youth will complete assessments at 4 data waves over one year and using a combination of: a) quantitative sensory testing of the pain modulation b) psychosocial assessment, and c) actigraphic monitoring of sleep, the central aim is to identify mechanisms in the transition from acute to chronic MSK pain. We will also characterize the contribution of sleep deficiencies, cognitive-affective vulnerabilities, parent pain-specific responses, and key child demographic characteristics in conferring risk for poor pain outcomes. The aims of this innovative study address a major gap in current pediatric MSK pain research by informing our understanding of how pain transitions from an acute to chronic state and will provide knowledge of early risk factors for developing chronic MSK pain. Data generated from this proposal will also directly inform our team's development of screening protocols and targeted preventive interventions directed at youth at greatest risk for developing chronic MSK pain. Aligning with the goals of the Federal Pain Strategy Research Report, with this research we shift the focus from treatment of chronic pain to prevention through early identification of at-risk youth.