Developmental Outcomes of Pediatric Chronic Abdominal Pain

描述（由申请人提供）：此修订后的申请是R01 HD23264的更新，其新标题反映了我们研究计划的不断发展的重点。我们的目标是了解与儿童慢性疼痛相关的生物社会心理过程，为预防和治疗提供信息。青年慢性腹痛（CAP）已作为一个原型，在我们的研究疼痛不相关的重大医学解释病理。这些年轻人被认为在青少年和成人时期有患功能性胃肠道疾病（fgid）、头痛、其他慢性疼痛疾病和精神疾病的风险。然而，没有前瞻性研究系统地评估这些结果。需要更多的信息来描述CAP的身体、情感和功能结果，发现不良结果的风险因素，并确定可能影响CAP从儿童期到青春期和青年期病程的心理、行为和生理因素。该应用程序利用了我们现有的具有里程碑意义的数据库，其中包括800多名8至15岁的CAP评估患者和350名类似年龄的健康儿童。我们的样本提供了一个独特的机会来确定我们数据库中青少年和年轻人（13-28岁）随访时儿科发病CAP的长期健康和社会心理结果的预测因子。将联系以前患有儿科发病- cap的研究参与者和以前作为对照组的参与者，进行详细的社会心理和实验室随访评估。因此，我们将对CAP患者进行评估，因为他们经历了与相当大的损害和卫生服务使用相关的几种疾病的“风险年龄”。我们的目标是(1)检查与正常对照相比，儿童发病CAP的青少年和成人的健康和功能结果（包括FGIDs、慢性疼痛障碍和精神障碍的诊断标准），(2)评估基线风险因素与长期结果之间的关系，(3)作为我们日记研究的后续研究，将急性压力与CAP症状联系起来。使用实验室方法，通过实验检查急性应激源对CAP和井对照的症状恶化和生理反应性的影响，并确定对应激源反应的潜在调节因子。该项目与公共卫生的相关性：该研究将确定青少年和青年时期最有可能发展为精神障碍和慢性疼痛的CAP青年的特征，并将提出在预防和治疗工作中应该解决的因素。

DESCRIPTION (provided by applicant): This revised application is for renewal of R01 HD23264 with a new title that reflects the evolving focus of our research program. Our goal is to understand bio-psychosocial processes associated with pediatric chronic pain with the aim of informing prevention and treatment. Youth with chronic abdominal pain (CAP) have served as a prototype in our study of pain not associated with significant medically explained pathology. These youth are thought to be at risk for functional gastrointestinal disorders (FGIDs), headache, other chronic pain disorders, and psychiatric disorders as adolescents and adults. However, no prospective studies have systematically assessed these outcomes. Additional information is needed to characterize physical, emotional, and functional outcomes of CAP, discover risk factors for adverse outcomes, and identify psychological, behavioral, and physiological factors that may influence the course of CAP from childhood to adolescence and young adulthood. This application capitalizes on our existing landmark database of more than 800 patients evaluated for CAP at ages 8 through 15 years and a similar age control group of 350 well children. Our sample presents a unique opportunity to identify predictors of long-term health and psychosocial outcomes of pediatric onset CAP for individuals in our database who will be adolescents and young adults (ages 13-28 years) at follow-up. Former study participants with pediatric onset-CAP and those previously serving as well controls will be contacted for detailed psychosocial and laboratory follow-up assessment. Thus, we will evaluate CAP patients as they pass through the "age of risk" for several disorders associated with considerable impairment and health service use. We aim to (1) examine health and functional outcomes (including diagnostic criteria for FGIDs, chronic pain disorders, and psychiatric disorders) in adolescents and adults with pediatric onset CAP compared to well controls, (2) assess the relation between baseline risk factors and long-term outcomes and, (3) as a follow-up to our diary study that linked acute stress to CAP symptoms, use laboratory methods to examine experimentally the impact of acute stressors on symptom exacerbation and physiological reactivity across CAP and well controls, and identify potential moderators of the response to stressors. Relevance of this project to public health: The study will identify characteristics of youth with CAP who are most likely to develop psychiatric disorders and chronic pain as adolescents and young adults and will suggest factors that should be addressed in prevention and treatment efforts.