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何影响从急性到慢性疼痛转变的理解 外伤仍然有限。外伤导致急诊就诊次数超过 3000 万人次，2.5 美国每年有 100 万人住院 受伤后发生慢性疼痛的风险显着增加 对于非西班牙裔黑人 (NHB) 患者与具有类似损伤的非西班牙裔白人 (NHW) 患者进行比较。 尽管 NHB 患者会经历更高程度的急性损伤后疼痛，并且更有可能转变为 与 NHW 患者相比，慢性疼痛，影响这种转变的生物行为和社会因素并不好 明白了。该提案的总体目标是提高对影响因素的理解 过渡到受伤后慢性疼痛并形成种族疼痛差异。为了实现我们的目标，我们将招募 150 名 来自 1 级创伤中心的 NHB 和 150 名患有创伤性骨科损伤的 NHW 成年人并评估疼痛 住院期间和每月随访期间的结果。首先，我们将找出相同点和不同点 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 假设疼痛敏感性越高（在医院通过定量感觉测试进行评估），急性疼痛程度越高 炎症生物标志物（hsCRP、TNFα、IL1β、IL-6）、更多负面认知（灾难化、疼痛/治疗） 期望），而较高的抑郁/创伤后应激症状将预测受伤后的慢性疼痛（即， NHB 和 NHW 患者出现慢性疼痛的几率更高、疼痛强度更大、干扰更大）。如果 慢性疼痛风险因种族而有所缓和，我们假设 NHB 的损伤后慢性疼痛相对于 NHW 患者的部分原因是生物行为危险因素较高。其次，我们将找出相似之处 以及社会因素对 NHB 和 NHW 患者损伤后慢性疼痛的解释程度的差异。 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）会 预测 NHB 和 NHW 患者的损伤后慢性疼痛，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减轻，我们 假设 NHB 患者的损伤后慢性疼痛比 NHW 患者更严重，部分原因是 社会风险因素水平较高。跨多个风险和保护因素的综合评估 生物心理社会模型的水平将促进对导致受伤后的途径的理解 NHB 和 NHW 成年人的慢性疼痛，包括与过渡到种族差异有关的因素 慢性疼痛。评估院内诱发疼痛敏感性作为损伤后慢性疼痛发展的预测因子 代表了一项重大创新。这些知识可以刺激经济高效、可扩展的屏幕的开发 医院环境可以纠正痛苦中的种族差异。研究人员聚集在一起进行这项多学科的研究 团队在创伤性损伤、慢性疼痛、定量感觉测试、 炎症、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。