Developmental Outcomes of Pediatric Chronic Abdominal Pain

描述(申请人提供)：本次修订后的申请是R01 HD23264的续期申请，新名称反映了我们研究计划不断发展的重点。我们的目标是了解与儿科慢性疼痛相关的生物心理社会过程，目的是为预防和治疗提供信息。青年慢性腹痛(CAP)是我们研究的与重大医学解释的病理学无关的疼痛的原型。这些年轻人被认为在青少年和成年时有患功能性胃肠道疾病(FGID)、头痛、其他慢性疼痛障碍和精神障碍的风险。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的生理、情感和功能结果，发现不良结果的危险因素，并确定可能影响CAP从儿童到青春期和青壮年的过程的心理、行为和生理因素。这一应用利用了我们现有的里程碑式的数据库，该数据库包含800多名8至15岁的CAP患者和350名健康儿童的类似年龄对照组。我们的样本为我们数据库中的青少年和年轻人(13-28岁)提供了一个独特的机会来确定儿童CAP发病的长期健康和心理社会结果的预测因素。将联系患有儿科首发-CAP的前研究参与者和之前同时担任对照的研究参与者，以进行详细的心理社会和实验室随访评估。因此，我们将评估CAP患者在经历与相当大的损伤和医疗服务使用相关的几种疾病的“风险年龄”时的情况。我们的目标是(1)与健康对照组比较，(1)检查患有慢性萎缩性胃炎的青少年和成人患者的健康和功能结果(包括FGID、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，以及(3)作为我们将急性应激与CAP症状联系起来的日记研究的后续行动，使用实验室方法从实验上检查急性应激源对CAP和Well对照组症状恶化和生理反应的影响，并确定压力源反应的潜在调节因素。本项目与公共卫生的相关性：该研究将确定患有CAP的年轻人的特征，他们在青少年时期最有可能发展为精神障碍和慢性疼痛，并将提出在预防和治疗工作中应解决的因素。

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.