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

确定青少年从急性肌肉骨骼疼痛转变为慢性肌肉骨骼疼痛的风险

• 批准号: 10246185
• 负责人: Amy S Lewandowski Holley
• 金额: $ 64.28万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10246185
• 关键词: Acute; Acute Pain; Address; Adolescence; Adolescent; Adult; Affect; Affective; Age; Anxiety; Behavioral; Characteristics; Child; Childhood; Chronic; Cognitive; Data; Data Collection; Development; Early identification; Eligibility Determination; Family health status; Future; Goals; Healthcare; Healthcare Systems; Impairment; Individual; Knowledge; Longitudinal cohort study; Mediating; Mediator of activation protein; Medical; Mental Depression; Modeling; Musculoskeletal Pain; Pain; Pain Research; Parents; Pathway interactions; Polysomnography; Prevalence; Prevention; Psychosocial Assessment and Care; Psychosocial Factor; Quality of life; Reporting; Research; Research Priority; Risk; Risk Factors; Sampling; Schools; Sensory; Sleep Deprivation; Testing; Time; Treatment Cost; United States; United States National Institutes of Health; Visit; Youth; actigraphy; biopsychosocial; central pain; central sensitization; chronic musculoskeletal pain; chronic pain; conditioned pain modulation; cost; disability; experience; follow-up; high risk; innovation; pain catastrophizing; pain inhibition; pain outcome; pain sensitivity; pain signal; physically handicapped; preventive intervention; prospective; protective behavior; psychosocial; response; sex; sleep pattern

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.

项目概要 肌肉骨骼 (MSK) 疼痛影响 18-32% 的青少年，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 斯隆疼痛变成慢性时，青少年会经历显着的心理社会症状 困难、身体残疾和学校功能受损。小儿慢性疼痛的治疗费用为 美国每年估计为 190 亿美元。迫切需要降低成本和影响 小儿慢性 MSK 疼痛，特别是 给定 那 疼痛、残疾和高医疗保健使用的风险可能 从青春期延伸到成年。关键的第一步是确定转型背后的机制 从青少年急性到慢性 MSK 疼痛。慢性疼痛的一个关键机制是敏化 中枢疼痛通路和条件性疼痛调节损伤。研究表明疼痛存在差异 与健康样本相比，患有慢性疼痛的儿童和成人的调节，以及较差的疼痛抑制 预测成人未来慢性疼痛的风险。知识上的一个关键差距是如何调节疼痛、社会心理 因素和行为脆弱性给青少年带来从急性 MSK 疼痛转变为慢性 MSK 疼痛的风险。作为 NIH 的联邦疼痛战略研究报告中概述，评估 插曲 预期 个人 急性疼痛的过程 慢性疼痛状态是研究的首要任务。需要 研究检查从急性疼痛到慢性疼痛的转变，以确定转变机制和 处于最大的风险。 此外，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研究 对患有急性 MSK 疼痛的青少年 (n=300) 进行队列研究，以测试从 急性至慢性疼痛。青少年将在一年内完成 4 次数据波的评估，并使用 组合：a) 疼痛调节的定量感官测试 b) 社会心理评估，以及 c) 睡眠的体动监测，其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、 父母对疼痛的特定反应，以及影响疼痛程度低的风险的关键儿童人口统计特征 结果。这项创新研究的目的是解决当前儿科 MSK 斯隆疼痛研究中的一个主要空白 让我们了解疼痛如何从急性状态转变为慢性状态，并提供知识 发展为慢性 MSK 疼痛的早期危险因素。该提案生成的数据也将直接告知 我们的团队针对青少年制定了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，通过这项研究，我们将重点从慢性疼痛的治疗转向通过早期预防 识别高危青少年。