Physiological and Emotional Reactivity to Pain after Physical and Sexual Abuse

描述（由申请人提供）：本提案详细介绍了一个短期职业发展计划，为肯塔基大学牙科学院经验丰富的临床行为科学家配对作为导师的经验丰富的疼痛研究科学家。教员级候选人的培训机会包括：(1)临床和转化科学（CTS）的正式证书培训和(2)临床口腔面部疼痛研究的指导培训。慢性疼痛是暴露于人际暴力后与创伤后应激障碍（PTSD）相关的一种长期持续但文献记载较少的结果。这项有指导的试点研究将在当地社区收容所有身体和/或性虐待史的妇女中进行。她的导师查尔斯·卡尔森博士（Charles Carlson）及其同事的实验室研究发现，PTSD与女性慢性口腔面部疼痛之间存在联系。这些慢性疼痛患者的生理反应变化包括心率变异性（HRV）降低。这种生理生物标志物反应性的改变表明它是介入策略的合适目标。最近的证据表明，控制呼吸速率和模式可以恢复心率变异的增加。卡尔森博士开发了一种自我调节呼吸的个人技能训练方法，可能有助于抵消因暴露于创伤性事件而引发的持久生理变化。假设：通过控制呼吸改善自主神经系统功能的自我调节可以抵消因暴露于创伤性事件而引起的疼痛性热应激引起的生理反应改变。目的1：评估经历过身体或性虐待的有/无PTSD症状的参与者的生理活动和情绪反应的差异。将对60名经历过人际暴力的参与者进行生理激活和情绪反应评估。参与者将填写问卷：情绪评估量表（EAS）、匹兹堡睡眠质量指数（PSQI）、创伤后应激障碍检查表（PCL-C）、自我报告抑郁量表（CES-D）和当前月经周期阶段。基线生理测量包括心率、潮末二氧化碳（ETCO2）和呼吸速率。目的2：研究对物理应激源（热刺激）的反应以及短暂的物理自我调节呼吸干预对生理变量的影响。在生理记录（心率，ETCO2，呼吸率）继续进行的同时，将单侧间歇性疼痛热刺激应用于口面部区域的物理应激源。该程序将在缓慢膈呼吸干预的指导后重复，该干预是使用随机数字表随机选择的一半参与者。该培训的长期目标是使候选人能够设计，执行和分析慢性口面部疼痛患者在正式CTS培训后的临床转化研究，并参与指导的试点研究，以了解身体/性虐待后创伤后应激障碍的不良生理结果。

DESCRIPTION (provided by applicant): This proposal details a short-term career enhancement plan for a seasoned pain research scientist paired with experienced clinical behavioral scientists in the College of Dentistry at the University of Kentucky, as mentors. The proposed training opportunity for the faculty level candidate includes: (1) formal Certificate training in Clinical and Translational Science (CTS) and (2) mentored training in a clinical orofacial pain study. Chronic pain is a long lasting but less well documented outcome associated with post-traumatic stress disorder (PTSD) after exposure to interpersonal violence. The mentored pilot study will be performed in women with a history of physical and/or sexual abuse from local community shelters. Laboratory findings of mentor, Dr. Charles Carlson, and his colleagues have established a link between PTSD and chronic orofacial pain for women. Coincident physiological response changes in these chronic pain sufferers include decreased heart rate variability (HRV). Alterations in responsivity of this physiological biomarker suggest it as an appropriate target for interventional strategies. Recent evidence suggests controlling rate and pattern of respiration can restore an increase in HRV. Dr. Carlson has developed a method of individual skills training in self-regulation of respiration that may help offset enduring physiological changes precipitated by exposure to traumatic events. Hypothesis: Improved self-regulation of autonomic nervous system function with controlled breathing can offset altered physiological responses to a painful heat stress precipitated by exposure to traumatic events. AIM 1: To evaluate differences in physiological activity and emotional reactivity in participants with/without PTSD symptoms who have experience physical or sexual abuse. Physiological activation and emotional reactivity will be assessed in 60 participants who have experienced interpersonal violence. Participants will fill out questionnaires: Emotion Assessment Scale (EAS), Pittsburgh Sleep Quality Index (PSQI), Post Traumatic Stress Disorder Checklist (PCL-C), Self Report Depression Scale (CES-D), and Current Stage of Menstrual Cycle. Baseline physiologic measures will include heart rate, end- tidal CO2 (ETCO2), and respiration rate. AIM 2: To study responses to a physical stressor (heat stimulation) and the effects of a brief physical self-regulation breathing intervention on the physiological variables. A physical stressor consisting of application of unilateral intermittent painfully hot stimulation will be applied to the orofacial area while physiological recordings (heart rate, ETCO2, respiration rate) continue. The procedure will be repeated after instruction in a slow diaphragmatic breathing intervention that is introduced to one-half of the participants selected at random using a table of random numbers. The long-term goal of this training is to prepare the candidate to design, perform and analyze clinical translational studies in patients with chronic orofacial pain after formal CTS training and participation in a mentored pilot study to understand adverse physiological outcomes of PTSD after physical/sexual abuse. PUBLIC HEALTH RELEVANCE: Severe psychological trauma produced by abuse can produce well characterized chronic physiological and psychological responses, including decreased heart rate variability and increased responsivity to pain. Individual skills training in self-regulation of respiration will be used to offset persisting physiological changes and increased reactivity to noxious heat-induced orofacial pain precipitated by exposure to traumatic physical or sexual abuse.