Determining Mechanisms of Pain Reduction in Chronic Widespread Pain After Rapid Weight Loss in Non-Hispanic Black and Hispanic/Latino/a/x Adults

项目总结/摘要 慢性广泛性疼痛（CWP）是一种慢性疼痛亚型，影响多个身体部位，并强烈 与功能低下和残疾有关。虽然CWP在肥胖成年人中非常普遍， 结果在非西班牙裔黑人（NH黑人）和西班牙裔/拉丁裔/a/x成年人中不成比例地更差。因此，在本发明中， CWP中与肥胖相关的健康差异可能会增加这些人群中现有的种族和民族疼痛差异， 人口数量。减肥手术通常用于治疗肥胖和肌肉骨骼疼痛合并症。 然而，减肥手术后体重减轻和疼痛轨迹存在显著差异。而且很多 患者在减肥手术后经历复发或未解决的疼痛，这可能抑制体重减轻或促进 体重恢复在我们对CWP成果的主要驱动因素以及如何实现这些驱动因素的认识方面存在重大差距。 CWP的驱动因素对体重减轻有反应，特别是在种族和民族多样化的群体中。因此，主要 为指导病人导向的研究职业发展的建议指导项目的目标 Award（K23）通过以下方式填补这些知识空白：1）全面表征休息和运动时的疼痛- 肥胖手术后NH黑人和西班牙裔/拉丁裔/a/x成年人的诱发性疼痛（MEP），以及2）识别潜在的 减肥手术后疼痛缓解或维持的组内变异性的关键驱动因素。我们将 重点关注疼痛敏感性、关节运动和机械负荷生物特征以及心理社会因素。目标 K23应用中提出的高度创新的方法，协同机制为基础的疼痛 表型与肥胖和健康差异的研究方法。所采用的方法是 从静态的、自我报告的疼痛评估实质性地偏离到严格评估的整合， 使用精确量化伤害性处理测量静息和MEP时疼痛的多个维度 以及不同种族人群中的关节运动和加载生物特征。对于K23，我已经组装了一个 强大的跨学科和多元文化的骨干非常成功的临床，基础和转化科学家谁 我有一个强有力的和可证明的承诺，以成功实施和完成我的职业生涯 发展计划和研究项目里程碑。主要的培训目标是我的 研究培训和职业发展是：1）发展减肥和 使用疼痛表型数据进行生活方式改变评估，2）开发和实施临床试验设计， 识别和解决疼痛差异，以及3）加强先进统计方法的培训，以告知临床 试验设计以检查疼痛差异。纽约大学（NYU）和佛罗里达大学实力很强 疼痛、肥胖和康复研究的孵化器此外，这些机构是强大的研究 环境，有资源可供我建立在我以前的培训，以促进独立， 这项研究的重点是改善不同种族和民族的肥胖成年人的疼痛管理。

Project Summary/Abstract Chronic widespread pain (CWP) is a chronic pain subtype that affects multiple body sites, and is strongly associated with poor function and disability. Although CWP is highly prevalent in adults with obesity, CWP outcomes are disproportionately worse in non-Hispanic Black (NH Black) and Hispanic/Latino/a/x adults. Thus, the obesity-related health disparity in CWP could augment existing racial and ethnic pain disparities in these populations. Bariatric surgery is often prescribed to treat obesity and musculoskeletal pain comorbidities. However, there is significant variability in weight loss and pain trajectories after bariatric surgery. Moreover, many patients experience recurrent or unresolved pain after bariatric surgery that can inhibit weight loss or facilitate weight regain. There are critical gaps in our knowledge of the primary driver(s) of CWP outcomes and how driver(s) of CWP respond to weight loss, particularly in racial and ethnically diverse groups. As such, the main objective of the proposed mentored project for the Mentored Patient-Oriented Research Career Development Award (K23) is to fill these knowledge gaps by: 1) comprehensively characterizing pain at rest and movement- evoked pain (MEP) in NH Black and Hispanic/Latino/a/x adults after bariatric surgery, and 2) identifying potential key driver(s) of intra-group variability in the resolution or maintenance of pain after bariatric surgery. We will focus on pain sensitivity, joint motion and mechanical loading biosignatures, and psychosocial factors. The aims proposed in this K23 application feature highly innovative methods that synergize mechanism-based pain phenotyping with obesity and health disparities research approaches. The methodologies employed represent a substantive departure from static, self-reported pain assessment to the integration of rigorous assessment and measurement multiple dimensions of pain at rest and MEP using precise quantification of nociceptive processing and joint motion and loading biosignatures in ethnically diverse populations. For the K23, I have assembled a strong interdisciplinary and multicultural cadre of highly successful clinical, basic, and translational scientists who have a strong and demonstrable commitment to the successful implementation and completion of my career development plan and research project milestones. The primary training goals that are the linchpin of my research training and career development are: 1) developing expertise in the integration of weight loss and lifestyle change evaluations with pain phenotyping data, 2) to develop and implement clinical trial designs that identify and address pain disparities, and 3) to enhance training in advanced statistical methods to inform clinical trial design to examine pain disparities. New York University (NYU) and the University of Florida are very strong incubators of pain, obesity, and rehabilitation research. Furthermore, these institutions are robust research environments that have the resources available to me to build on my previous training to foster independence in research that is focused on improving pain management in racially and ethnically diverse adults with obesity.