An in-depth Examination of the Psychological Processes involved in the Transition from Acute to Chronic Pain after a Traumatic Musculoskeletal Injury

深入研究创伤性肌肉骨骼损伤后从急性疼痛转变为慢性疼痛的心理过程

• 批准号: 10088415
• 负责人: Maria Lynn Pacella
• 金额: $ 12.33万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10088415
• 关键词: Accident and Emergency department; Acute; Acute Pain; Age; Agreement; Anxiety; Autonomic nervous system; Behavior; Behavioral; Belief; Biological Markers; Chronic; Clinical Trials Design; Cognition; Cognitive; Cognitive Therapy; Collection; Country; Data; Data Collection; Development; Devices; Distress; Ecological momentary assessment; Electronic Mail; Emergency department visit; Emotional; Emotions; Environment; Evolution; Fostering; Fright; Future; Goals; Heart Rate; High Prevalence; Hour; Individual; Injury; Interruption; Intervention; Intervention Trial; Longitudinal Studies; Measures; Mediating; Mental Depression; Mental disorders; Modeling; Monitor; Motorcycles; Movement; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Numeric Rating Scale; Opioid; Pain; Pain intensity; Pain interference; Pain management; Patient Self-Report; Patients; Pattern; Persons; Pharmacology; Phase; Physiological; Population; Prevention; Prevention strategy; Process; Prospective cohort study; Psychological Factors; Reaction; Recording of previous events; Recovery; Reporting; Research; Research Activity; Research Personnel; Resolution; Rest; Risk; Risk Factors; Savings; Secondary pain; Severities; Stress; Surveys; Symptoms; System; Techniques; Text Messaging; Time; Training; Training Activity; Trauma; Trauma patient; United States; Universities; Vehicle crash; Work; anxiety sensitivity; biopsychosocial; biopsychosocial factor; career development; chronic pain; chronic pain management; coping; craving; data management; design; disability; disability-adjusted life years; emotional factor; fitbit; high risk; improved; indexing; injured; innovation; multidisciplinary; multimodality; musculoskeletal injury; novel; opioid overuse; pain chronification; pain outcome; pain relief; pain score; patient oriented research; point of injury; post-traumatic stress; prevent; programs; prospective; psychologic; recruit; response; secondary analysis; sensor; sex; skills; therapy design; treatment strategy; years of life lost

PROJECT SUMMARY/ABSTRACT Identifying modifiable biopsychosocial factors that can reduce the high proportion (>20%) of injured patients who transition from acute pain (AP) to chronic pain (CP) could reduce the burden and disability from this condition. Maladaptive cognitive-behavioral strategies (e.g., fear-avoidance beliefs; catastrophizing) and emotional factors (e.g., general distress) are consistently associated with post-injury pain, especially in patients with pre-injury psychological vulnerabilities. However, it is unknown whether these psychological processes are causal in the transition from post-injury AP to CP, and are thus a target for CP prevention. For this K01 proposal, I will conduct a prospective cohort study in 200 motor vehicle crash patients with musculoskeletal injury to determine the temporal associations between maladaptive psychological processes and the development of CP. Preliminary data support the feasibility of recruitment and retention, the use of electronic communication, and collection of longitudinal data among trauma patients. We aim to: 1. Examine the concurrent association of psychological and physiological (heart rate activity and 24-hour activity patterns) processes with average levels of injury-related pain intensity throughout 3-months post-injury; 2. Determine the time windows when specific maladaptive cognitive-behavioral and emotional processes appear during the transition from injury-related AP to CP; and 3. Assess the biopsychosocial moderators of the transition from injury-related AP to CP. We will intensively examine interactions of cognitive-behavioral and emotional factors from the point of injury (emergency department) to acute (< 4 weeks), subacute (≈ 4 to 12 weeks post-injury), and chronic (> 12 weeks post-injury) time periods. We will augment traditional retrospective self-report surveys with prospective ecological momentary assessment (EMA) via text messages and biomarkers of distress via Fitbit devices. This project will foster career development through hands-on training in: 1. The design and conduct of rigorous prospective research on the transition to CP/disability after musculoskeletal injury and on clinical trial design for secondary pain prevention; 2. The use of multimodal techniques to measure and monitor post-injury maladaptive psychological and physiological responses and pain-related processes; 3. The data management, analysis and interpretation of a prospective, longitudinal study with intensive data collection; and 4. Grantsmanship skills. These proposed research and training activities will capitalize on the multidisciplinary environment at the University of Pittsburgh to advance strategies for pain prevention. This goal is well-aligned with the NIAMS Long-Range Plan for FY 2015-2019 to use multidisciplinary, multilevel, and non-pharmacological approaches to prevent chronic pain (CP) in the injury population at large. This K01 application will help the PI launch an independent program of impactful patient- oriented research to become an independent investigator with expertise in: 1) the psychological contributors to CP, and 2) prevention efforts to reduce the burden of CP and improve recovery after acute physical injury.

项目总结/摘要 确定可改变的生物心理社会因素，可以减少受伤患者的高比例（> 20%）， 从急性疼痛（AP）到慢性疼痛（CP）的转变可以减轻这种状况的负担和残疾。 不适应的认知行为策略（例如，恐惧回避信念;灾难化）和情感因素 (e.g.,一般痛苦）与伤后疼痛一致相关，尤其是在伤前疼痛的患者中。 心理脆弱性然而，这些心理过程是否是因果关系尚不清楚。 从损伤后AP到CP的过渡，因此是CP预防的目标。对于K01提案，我将进行 在200名机动车碰撞合并肌肉骨骼损伤患者中进行的一项前瞻性队列研究， 适应不良的心理过程和CP的发展之间的时间关联。初步 数据支持招聘和保留的可行性，使用电子通信，以及收集 创伤患者的纵向数据。我们的目标是：1.检查心理和心理的并发关联， 生理（心率活动和24小时活动模式）过程与损伤相关的平均水平 损伤后3个月内的疼痛强度; 2.确定特定适应不良时的时间窗 认知-行为和情绪过程出现在从损伤相关AP到CP的过渡过程中; 3. 评估从损伤相关AP向CP转变的生物心理社会调节因素。我们将深入研究 认知行为和情感因素的相互作用，从受伤点（急诊科）到 急性期（<4周）、亚急性期（损伤后14 - 12周）和慢性期（损伤后> 12周）。 我们将用前瞻性的生态瞬时评估来补充传统的回顾性自我报告调查 (EMA)通过短信和Fitbit设备的痛苦生物标记。该项目将促进职业发展 通过以下方面的实践培训：1.设计和进行关于向联合国过渡的严格的前瞻性研究， 肌肉骨骼损伤后CP/残疾和二级疼痛预防的临床试验设计; 2.使用 测量和监测创伤后适应不良的心理和生理的多模式技术 反应和疼痛相关过程; 3.数据管理，分析和解释的前瞻性， 纵向研究与密集的数据收集;和4.精湛的技艺。这些研究和 培训活动将利用匹兹堡大学的多学科环境， 预防疼痛的策略。这一目标与NIAMS 2015 - 2019财年的长期计划保持一致， 使用多学科、多层次和非药物方法预防损伤中的慢性疼痛（CP） 一般人口。此K01应用程序将帮助PI启动一个独立的有影响力的患者项目- 面向研究，成为一个独立的调查员，在专业知识：1）心理因素， CP，和2）预防工作，以减少CP的负担和改善急性身体损伤后的恢复。