Pain in community-based older African American Adults: The Jackson Heart Study

社区老年非裔美国成年人的疼痛：杰克逊心脏研究

• 批准号: 10470948
• 负责人: Emelia J. Benjamin
• 金额: $ 63.84万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10470948
• 关键词: Abdominal Pain; Address; Admission activity; Adult; Affect; African American; African American population; American; American Heart Association; Anatomy; Arthralgia; Back Pain; Body part; Cessation of life; Chronic; Cohort Studies; Communities; Data; Degenerative polyarthritis; Development; Diagnosis; Disease; Distress; Elderly; Epidemiologist; Epidemiology; Evaluation; Evolution; Funding; Health Personnel; High Prevalence; Incidence; Individual; Institutionalization; Interdisciplinary Study; International; Jackson Heart Study; Joints; Knowledge; Life; Location; Low Prevalence; Maintenance; Measures; Migraine; Musculoskeletal; Neurologic; Nursing Homes; Outcome; Pain; Pain management; Pathway interactions; Patient-Focused Outcomes; Patients; Physical Function; Population; Prevalence; Preventive; Psychologist; Psychosocial Factor; Public Health; Risk; Risk Factors; Sampling; Sensory; Severities; Social Network; Social support; Specialist; Spirituality; Stress; System; Testing; Therapeutic; Time; Visit; Work; base; body system; care coordination; chronic pain; chronic painful condition; cohort; conditioned pain modulation; coping; cost estimate; disability; follow up assessment; follow-up; gastrointestinal; healthy lifestyle; human old age (65+); innovation; insight; lifestyle factors; mortality; mortality risk; multidisciplinary; negative affect; neurophysiology; novel; optimism; pain processing; psychosocial; racial health disparity; resilience; rheumatologist; social health determinants; social influence; stressor; surveillance study; years lived with disability

Chronic pain affects over 100 million American adults, with an estimated cost of $560-635 billion annually, yet this major burden is relatively understudied in African Americans (AAs). Older adults are at increased risk of having multiple painful conditions and are living longer with the negative impacts of chronic pain. Chronic pain, regardless of anatomy or diagnosis involved (e.g., back pain, migraine), is the leading cause of disability worldwide. Limited insights into whether common mechanisms underlie all pain conditions, regardless of diagnosis, has contributed to inadequate pain management options. Health care providers who treat one pain condition (e.g., joint pain) typically do not manage symptoms in other parts of the body (e.g., abdominal pain), and patients are often referred from one specialist to another. Studying commonalities of various chronic overlapping pain conditions (COPC) in community-based cohorts unselected for pain conditions can provide novel insights into causes and consequences of chronic pain as a disease itself. For example, neurophysiologic alterations in pain processing such as pain sensitization (assessing ascending pain pathways) and conditioned pain modulation (CPM) (assessing descending pain modulation) may be common mechanisms underlying all chronic pain. Such knowledge would spur development of novel pain management approaches for all types of pain regardless of anatomy or diagnosis involved. Despite the substantial public health burden of chronic pain, little is known about the epidemiology and evolution of COPC in older AA adults, nor of the impact of COPC on physical or psychosocial function, risk of nursing home admission, and mortality in older AAs. We propose to evaluate chronic pain in the upcoming study visit of a thoroughly-characterized community-based older AA cohort unselected for any pain complaints, the Jackson Heart Study (JHS) (N~2540, two-thirds ≥age 65). We aim to understand the epidemiology of COPC, regardless of anatomy or diagnosis involved, the evolution of COPC over time, neurophysiologic alterations in pain processing, healthy lifestyle factors and psychosocial factors as risk factors for COPC, and consequences of COPC and altered pain processing in older adults. We propose acquiring objective quantitative sensory testing (QST) measures of pain sensitization and CPM, which are associated with pain severity in experimental settings. Whether QST-assessed neurophysiologic alterations may be common underlying risk factors for all forms of chronic pain, and for poor physical and psychosocial functioning, institutionalization, and mortality in a community-based cohort of older AAs unselected for pain is unknown. We will collect data regarding a multitude of chronic pain conditions, QST, healthy lifestyle factors, physical and psychosocial function, and nursing home admissions during the next planned study visit, as well as two follow-up assessments to obtain longitudinal data, and leverage the ongoing JHS surveillance of mortality. Our work will address several knowledge gaps, and insights gained may ultimately facilitate new preventive and therapeutic approaches to relieving chronic pain and its consequences, regardless of underlying diagnosis.

慢性疼痛影响着1亿多美国成年人，每年的成本估计为5600 - 6350亿美元