Mechanisms of transition from acute to chronic pain in Non-Hispanic Black and White injury patients

非西班牙裔黑人和白人损伤患者从急性疼痛转变为慢性疼痛的机制

• 批准号: 10703490
• 负责人: Matthew C. Morris
• 金额: $ 66.41万
• 依托单位: UNIVERSITY OF MISSISSIPPI MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-11 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10703490
• 关键词: Accounting; Acute; Address; Adult; Age; Biological Markers; Black race; Buffers; Characteristics; Chronic; Cognition; Development; Disease susceptibility; Disparity; Early Intervention; Elements; Emergency department visit; Fracture; Gender; Health Care Visit; Healthcare; Hospitalization; Hospitals; Individual; Inflammation; Inflammatory; Injury; Interleukin-1 beta; Interleukin-6; Knowledge; Life; Measures; Mediation; Medical; Methods; Modeling; Neighborhoods; Not Hispanic or Latino; Orthopedics; Pain; Pain Measurement; Pain intensity; Pain interference; Pathway interactions; Patients; Perception; Prospective Studies; Psychopathology; Race; Reporting; Research Personnel; Risk; Risk Assessment; Risk Factors; Sensory; Severities; Shapes; Social support; Socioeconomic Status; Stress; Stressful Event; Surveys; TNF gene; Testing; Traumatic injury; Work; biobehavior; biopsychosocial; black patient; chronic pain; chronic painful condition; clinical pain; cost effective; depressive symptoms; expectation; experience; functional disability; improved; inflammatory marker; injured; innovation; low socioeconomic status; minority stress; multidisciplinary; novel; pain chronification; pain outcome; pain sensitivity; post-traumatic stress; post-traumatic symptoms; predictive modeling; protective factors; racial difference; racial disparity; recruit; sample fixation; skills; social; social factors; social health determinants; social influence; theories; trauma centers

Current understanding of how and why race influences the transition from acute to chronic pain following traumatic injury remains limited. Traumatic injuries result in over 30 million emergency department visits and 2.5 million hospitalizations each year in the U.S. Risk for developing post-injury chronic pain is significantly greater for non-Hispanic Black (NHB) patients compared to non-Hispanic White (NHW) patients with similar injuries. Although NHB patients experience higher levels of acute post-injury pain and are more likely to transition to chronic pain than NHW patients, the biobehavioral and social factors that influence this transition are not well understood. The overall aim of this proposal is to improve understanding of the factors that influence the transition to post-injury chronic pain and shape racial pain disparities. To address our aims, we will recruit 150 NHB and 150 NHW adults with traumatic orthopedic injuries from a level 1 trauma center and assess pain outcomes during hospitalization and across monthly follow-ups. First, we will identity similarities and differences in the extent to which biobehavioral factors explain post-injury chronic pain in NHB and NHW patients. We hypothesize that greater pain sensitivity (assessed in hospital via quantitative sensory testing), elevated acute inflammatory biomarkers (hsCRP, TNFα, IL1β, IL-6), more negative cognitions (catastrophizing, pain/treatment expectations), and higher depressive/posttraumatic stress symptoms will predict post-injury chronic pain (i.e., higher odds of chronic pain onset, greater pain intensity and interference) in both NHB and NHW patients. If chronic pain risks are moderated by race, we hypothesize that worse post-injury chronic pain in NHB relative to NHW patients will be explained, in part, by higher biobehavioral risk factors. Second, we will identify similarities and differences in the extent to which social factors explain post-injury chronic pain in NHB and NHW patients. We hypothesize that social risk factors (greater life and neighborhood stress, lower socioeconomic status) will predict post-injury chronic pain in both NHB and NHW patients, and that social protective factors (higher social support) will buffer against in the influence of social risk factors. If chronic pain risks are moderated by race, we hypothesize that worse post-injury chronic pain in NHB relative to NHW patients will be explained, in part, by higher levels of social risk factors. The comprehensive assessment of risk and protective factors across multiple levels of the biopsychosocial model will advance understanding of the pathways that contribute to post-injury chronic pain for both NHB and NHW adults, including factors implicated in racial differences in transition to chronic pain. Evaluating in-hospital evoked pain sensitivity as a predictor of post-injury chronic pain development represents a major innovation. This knowledge could spur the development of cost-effective, scalable screens for hospital settings to redress racial disparities in pain. The investigators assembled for this multidisciplinary team possess complementary skill sets in traumatic injury, chronic pain, quantitative sensory testing, inflammation, pain-relevant biobehavioral and social factors, and racial disparities in chronic pain.

目前对种族如何以及为什么影响从急性疼痛向慢性疼痛的转变的理解 创伤性损伤仍然有限。创伤导致3000多万人次到急诊科就诊，2500万人次 美国每年有数百万人住院。患上损伤后慢性疼痛的风险要大得多 对于有类似损伤的非西班牙裔黑人(NHB)患者和非西班牙裔白人(NHW)患者进行比较。 尽管NHB患者经历了更高水平的急性损伤后疼痛，并且更有可能过渡到 与NHW患者相比，影响这种转变的生物行为和社会因素不是很好 明白了。这项建议的总体目标是提高对影响经济增长的因素的了解 过渡到受伤后的慢性疼痛，并形成种族疼痛差异。为了达到我们的目标，我们将招聘150人 来自一级创伤中心的NHB和150 NHW成人创伤骨科损伤并评估疼痛 住院期间和每月随访的结果。首先，我们将找出相似和不同 生物行为因素在多大程度上解释NHB和NHW患者受伤后的慢性疼痛。我们 假设更高的疼痛敏感度(在医院通过定量感觉测试进行评估)，提高急性 炎症生物标志物(超敏C反应蛋白、肿瘤坏死因子α、白介素1β、白介素6)、更多负面认知(灾难、疼痛/治疗 预期)，较高的抑郁/创伤后应激症状将预测伤害后慢性疼痛(即， 在NHB和NHW患者中，慢性疼痛发作的几率更高，疼痛强度和干扰更大)。如果 慢性疼痛风险受种族影响较小，我们假设NHB中损伤后更严重的慢性疼痛相对于 NHW患者将被较高的生物行为风险因素部分解释。第二，我们将找出相似之处 以及社会因素在解释NHB和NHW患者受伤后慢性疼痛的程度上的差异。 我们假设社会风险因素(更大的生活和邻里压力，更低的社会经济地位)将 预测NHB和NHW患者受伤后的慢性疼痛，以及社会保护因素(较高的社会保护因素 支持)将缓冲社会风险因素的影响。如果慢性疼痛风险因种族而降低，我们 假设相对于NHW患者，NHB患者受伤后慢性疼痛的恶化将部分解释为 社会风险因素水平较高。跨多个领域的风险和保护因素综合评估 生物-心理-社会模型的水平将促进对导致损伤后的途径的理解 NHB和NHW成人的慢性疼痛，包括与过渡到 慢性疼痛。评估医院内诱发疼痛敏感性作为创伤后慢性疼痛发展的预测因子 代表着一项重大创新。这一知识可能会刺激成本效益高的可扩展屏幕的开发 用于医院环境，以纠正疼痛中的种族差异。调查人员为这项多学科的研究聚集在一起 团队在创伤、慢性疼痛、定量感觉测试、 炎症、与疼痛相关的生物行为和社会因素，以及慢性疼痛的种族差异。