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 脑性瘫痪(CP)是最常见的儿童发病肢体残疾，估计患病率 在美国，每1000名活产中有2.6-3.1例。目前尚缺乏临床随访 从儿童初级保健过渡到成人初级保健后的CP患者，队列数据不足，无法追踪 纵向的临床结果。疼痛是慢性前列腺炎患者最常见的躯体症状。 寿命，然而慢性疼痛可能是最不被理解、强调和研究的身体共病 Cp.慢性肌肉痉挛、关节疼痛可能源于慢性肌肉痉挛、关节的伤害性机制。 错位，侵入性和重复性的外科手术。或者，神经性疼痛可能是一种 脑室周围白质软化导致非伤害性感觉束功能障碍的后果 大多数脑性瘫痪患者的神经元。到目前为止，几乎没有任何调查需要了解 成人CP患者的疼痛表型分布和治疗差异，以及差异有多大 管理战略会导致身体和心理的发病率和多发病。理解 成人CP患者慢性疼痛的表型对于开出最合适和 有效的疼痛管理干预措施。这项创新的研究建议检查疼痛和 成人CP患者的多发病与非CP成人之间的比较，并进一步了解 在疼痛管理方面，种族/民族和保险类型(联邦医疗保险与私人)。尽管理解了 成人CP患者的疼痛机制对于处方最合适和有效的疼痛是至关重要的 在管理干预方面，许多患有CP的成年人目前都收到了阿片类药物处方。因此，至关重要的是 还要检查这些止痛药和替代疗法/疗法对长期和长期的影响 这一人群的长期健康结果。检查疼痛管理不善的程度也是至关重要的 在这一人群中调节导致慢性疾病和多发病的轨迹。这项研究是我们 这里提出的建议通过利用几个唯一的数据集来填补这一关键的知识空白，这些数据集表示 人口-具有代表性的联邦保险和私人保险的美国成人CP受益人样本。我们的 制定这种有针对性的干预措施的基础目标是比较患病率和 私人和联邦保险成人中慢性伤害性、神经病理性和伤害性疼痛的发生率 在全美使用CP(目标1)；并量化慢性疼痛和阿片类药物处方的中介效应 慢性阻塞性肺病患者的身心健康、发病率和多发病的模式(目标2)。最后一点 目标3将通过以下方式确定疼痛管理/治疗战略的差异和有效性 种族/族裔和保险类型，考虑到健康的社会决定因素。生成的数据来自 这项研究将带来有关疼痛、发病率的自然历史和轨迹的新知识 集群，以及患有CP的成年人之间的医疗保健差异。