Identifying Chronic Pain Phenotypes and Treatment Disparities in Adults with Cerebral Palsy

识别成人脑瘫患者的慢性疼痛表型和治疗差异

• 批准号: 10596875
• 负责人: Mark D Peterson
• 金额: $ 42.9万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2024-09-22
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10596875
• 关键词: Acute; Adult; Analgesics; Categories; Cerebral Palsy; Child; Childhood; Chronic; Clinical; Data; Data Set; Diagnosis; Effectiveness; Ethnic Origin; Ethnic group; Etiology; Fibromyalgia; Foundations; Functional disorder; Future; General Population; Grouping; Health; Healthcare; Helping to End Addiction Long-term; Impairment; Incidence; Insurance; International; Interstitial Cystitis; Intervention; Investigation; Irritable Bowel Syndrome; Joints; Knowledge; Life Expectancy; Literature; Live Birth; Long-Term Effects; Longevity; Mediating; Medicare; Mental Depression; Mental Health; Migraine; Minority; Minority Groups; Morbidity - disease rate; Muscle Spasticity; Musculoskeletal Pain; Names; National Institute of Child Health and Human Development; Natural History; Neuraxis; Neurobiology; Neurons; Neuropathy; Nociception; Operative Surgical Procedures; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Patients; Pattern; Periventricular Leukomalacia; Persons; Phenotype; Population; Prevalence; Primary Health Care; Privatization; Race; Reporting; Research; Risk; Role; Sampling; Sensory; Sleep disturbances; Symptoms; System; Tissues; Underrepresented Minority; United States; Work; alternative treatment; beneficiary; biopsychosocial; central pain; central sensitization; chronic pain; cohort; common symptom; comorbidity; experience; follow-up; health care disparity; health disparity populations; high risk; innovation; mental health related disorder; multiple chronic conditions; pain processing; painful neuropathy; peripheral pain; physical conditioning; physically handicapped; prescription opioid; psychologic; racial and ethnic; social health determinants; somatosensory; treatment disparity; treatment strategy; virtual

Summary/Abstract Cerebral Palsy (CP) is the most common pediatric-onset physical disability, with an estimated prevalence ranging from 2.6-3.1 cases per 1,000 live births in the United States. There is a lack of clinical follow-up for patients with CP after they transition from pediatric to adult primary care, and insufficient cohort data to track clinical outcomes longitudinally. Pain is the most commonly reported somatic symptom in CP throughout the lifespan, and yet chronic pain is perhaps the least understood, emphasized, and studied physical comorbidity of CP. Pain in CP may arise from nociceptive mechanisms associated with chronic muscle spasticity, joint misalignment, and invasive and repetitive surgical procedures. Alternatively, neuropathic pain could be a consequence of periventricular leukomalacia, which causes dysfunction of non-nociceptive sensory tract neurons in the majority of patients with CP. To date, there have been virtually no investigations to understand the pain phenotype distribution and treatment disparities among adults living with CP, and how differing pain management strategies contribute to physical and psychological morbidity and multimorbidity. Understanding the phenotypes of chronic pain among adults with CP is crucial for prescribing the most appropriate and effective pain management interventions. This innovative study proposes to examine the risk of pain and multimorbidity among adults with CP as compared to adults without CP, and to further understand the role of race/ethnicity and insurance type (Medicare vs. private) on pain management. Although understanding the mechanisms of pain among adults with CP is crucial for prescribing the most appropriate and effective pain management interventions, many adults with CP currently receive opioid prescriptions. Therefore, it is vital to also examine the short and long-term effects of these analgesics and alternative treatments/therapies on long- term health outcomes in this population. It is also critical to examine the extent to which mismanaged pain mediates the trajectories leading to chronic morbidity and multimorbidity in this population. The study we propose herein fills this critical gap in knowledge by leveraging several unique datasets representing a population-representative sample of federally- and privately insured beneficiaries of U.S. adults with CP. Our objectives, foundational to developing such targeted interventions, are to compare the prevalence and incidence of chronic nociplastic, neuropathic, and nociceptive pain among privately and federally insured adults with CP throughout the U.S (Aim 1); and quantify the mediating effect of chronic pain and opioid prescribing patterns on physical and mental health morbidity and multimorbidity among persons with CP (Aim 2). Lastly Aim 3 will determine the disparities in and effectiveness of pain management/treatment strategies by race/ethnicity and insurance type, taking into account the social determinants of health. Data generated from this study will lead to new knowledge pertaining to the natural history and trajectories of pain, morbidity clusters, and healthcare disparities among adults with CP.

摘要/摘要 脑瘫（CP）是最常见的儿科发作的身体残疾，估计患病率 在美国，每1000例活产的2.6-3.1病例。缺乏临床随访 CP患者从小儿过渡到成人初级保健，并不足 纵向临床结果。疼痛是整个CP中最常见的躯体症状 生命周期，但慢性疼痛也许是最不理理解，强调和研究的身体合并症 CP。 CP的疼痛可能来自与慢性肌肉痉挛相关的伤害感受机制，关节 错位，侵入性和重复的手术程序。或者，神经性疼痛可能是 脑室周围白细胞菌的后果，导致非伤害性感觉障碍的功能障碍 大多数CP患者的神经元。迄今为止，几乎没有调查要理解 CP的成年人的疼痛表型分布和治疗差异以及疼痛的不同 管理策略有助于身体和心理发病率和多个多发病。理解 CP成年人中慢性疼痛的表型对于开处方最合适的和 有效的疼痛管理干预措施。这项创新的研究建议检查疼痛的风险和 与没有CP的成年人相比 关于疼痛管理的种族/民族和保险类型（Medicare vs.私人）。虽然了解 CP成人疼痛的机制对于开处方最合适，最有效的疼痛至关重要 管理干预措施，许多患有CP的成年人目前接受阿片类药物处方。因此，至关重要 还要检查这些镇痛药和替代疗法/疗法对长期的短期和长期影响 该人群中的健康状况。检查痛苦不善的程度也很重要 介导导致该人群的慢性发病率和多发菌的轨迹。我们的研究 在此提出的提议通过利用代表A的几个独特数据集来填补知识的关键差距 美国成年人的联邦和私人保险受益人的人口代表性样本。我们的 目标是制定此类有针对性干预措施的基础，是为了比较患病率和 私人和联邦政府有保险的成年人的慢性疾病，神经性和伤害性疼痛的发病率 在整个美国拥有CP（AIM 1）；并量化慢性疼痛和阿片类药物处方的介导作用 CP患者的身体和心理健康发病率和多种多发病的模式（AIM 2）。最后 AIM 3将通过 种族/民族和保险类型，考虑到健康的社会决定因素。生成的数据 这项研究将导致与疼痛，发病率的自然史和轨迹有关的新知识 CP成年人的集群和医疗保健差异。