Ethnic Differences in Acute Pain and Analgesic Response

描述（申请人提供）：疼痛是威胁美国最昂贵和最普遍的公共卫生问题之一。虽然种族差异的疼痛及其治疗已被报道，种族对镇痛药的反应的影响很少受到关注。本研究将使用常见的急性临床疼痛模型来识别和表征导致疼痛感知和镇痛种族差异的社会心理、生理和遗传因素。目的1将确定种族群体的感知和生理反应的急性术后疼痛，并检查这些是如何与遗传，术前心理和社会心理因素。目的2将确定阿片类镇痛和副作用的种族差异，并检查遗传，药代动力学（PK），药效学（PD）和心理社会因素，解释镇痛反应的组间差异。本研究将纳入200名接受第三磨牙拔除的非洲裔美国人和白色成人（年龄范围18-55岁）。我们将评估术前实验性疼痛反应和心理社会措施。我们将监测术后疼痛水平沿着对阿片类芬太尼的PK和PD反应。我们将评估术后疼痛以及术后几小时内和术后3天内的镇痛反应的组间差异。我的目标是建立一个基础，在此基础上建立一个独立的研究生涯在临床相关的实验神经科学疼痛研究。拟议的培训和指导研究将最终提高我的生物心理社会因素，有助于健康差距的理解。我提出了4个主要的培训目标：1）发展心理物理和临床疼痛评估的专业知识，重点是种族差异; 2）了解复杂的遗传，PK/PD过程涉及术后疼痛和镇痛反应; 3）增加先进的生物统计方法的知识;和4）提高对种族差异急性疼痛和镇痛相关因素的理解。我的长期职业目标是开发一个旨在阐明生物心理社会对疼痛种族差异的贡献的程序性研究路线。最终，我将从事转化研究，以减少临床疼痛的健康差异，通过开发旨在提高疼痛个人生活质量的干预措施，符合NINDS的战略计划。

DESCRIPTION (provided by applicant): Pain is one of the most costly and pervasive public health problems threatening the Untied States. While ethnic disparities in pain and its treatment have been reported, the influence of ethnicity on responses to analgesics has received scant attention. This study will use a common acute clinical pain model to identify and characterize psychosocial, physiological and genetic factors that contribute to ethnic group differences in pain perception and analgesia. Aim 1 will determine ethnic group differences in perceptual and physiological responses to acute post-operative pain and to examine how those are related to genetic, pre-operative psychophysical and psychosocial factors. Aim 2 will determine ethnic differences in opioid analgesia and side effects and to examine genetic, pharmacokinetic (PK), pharmacodynamic (PD), and psychosocial factors that explain group differences in analgesic responses. 200 African American and white adults (age range 18-55) who undergo third molar extraction will be included in this study. We will assess preoperative experimental pain responses and psychosocial measures. We will monitor postoperative pain levels along with PK and PD responses to the opioid fentanyl. We will assess group differences in post-operative pain as well as analgesic responses immediately for several hours post surgery and up to 3 days post-procedure. My objectives are designed to establish a foundation upon which to build an independent research career in clinically-relevant experimental neuroscience pain research. The proposed training and mentored research will ultimately enhance my understanding of biopsychosocial factors that contribute to health disparities. I propose 4 main training objectives: 1) Develop expertise in psychophysical and clinical pain assessment with emphasis on ethnic differences; 2) Gain an understanding of the complex genetic, PK/PD processes involved in post-operative pain and analgesic responses; 3) Increase knowledge in advanced biostatistical methodology; and 4) Improve understanding of factors related to ethnic differences acute pain and analgesia. My long-term career goal is to develop a programmatic line of research designed to elucidate biopsychosocial contributions to ethnic differences in pain. Eventually, I would engage in translational research to reduce health disparities in clinical pain through the development of interventions designed to enhance the quality of life of individuals with pain, consistent with the strategic plan of NINDS.