Physiological and Emotional Reactivity to Pain after Physical and Sexual Abuse

描述(由申请人提供)：这份提案详细介绍了一位经验丰富的疼痛研究科学家与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短期职业发展计划。建议的培训机会包括：(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性培训。慢性疼痛是一种长期持续但文献较少的结果，与接触人际暴力后的创伤后应激障碍(PTSD)有关。这项有指导的试点研究将在有身体和/或性虐待史的妇女中进行，这些妇女来自当地社区收容所。Mentor的实验室发现，Charles Carlson博士和他的同事们已经确定了创伤后应激障碍和女性慢性口腔面部疼痛之间的联系。这些慢性疼痛患者的一致生理反应变化包括心率变异性(HRV)降低。这一生理生物标记物的响应性改变表明它是介入治疗的合适靶点。最近的证据表明，控制呼吸速度和模式可以恢复HRV的增加。卡尔森博士已经开发出一种自我调节呼吸的个人技能训练方法，这种方法可能有助于抵消暴露在创伤事件中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，可以抵消因暴露在创伤事件中而导致的痛苦热应激的生理反应变化。目的1：评价有无创伤后应激障碍症状的受试者在生理活动和情绪反应方面的差异。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的评估。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)和月经周期当前阶段。基线生理测量将包括心率、呼气末二氧化碳分压(ETCO2)和呼吸频率。目的：研究对物理应激源(热刺激)的反应以及短暂的身体自我调节呼吸干预对生理变量的影响。在继续进行生理记录(心率、二氧化碳分压、呼吸频率)的同时，对口腔面部施加由单侧间歇疼痛热刺激组成的物理应激源。在指导了缓慢的横隔膜呼吸干预后，将重复这一过程，使用随机数字表将该干预引入随机选择的一半参与者。这项培训的长期目标是准备候选人在接受正式的CTS培训后，设计、执行和分析慢性口腔面部疼痛患者的临床转化研究，并参与一项有指导的试点研究，以了解身体/性虐待后创伤后应激障碍的不利生理后果。 公共卫生相关性：虐待造成的严重心理创伤可产生具有良好特征的慢性生理和心理反应，包括心率变异性降低和对疼痛的反应性增加。将使用自我调节呼吸的个人技能培训来抵消持续的生理变化和对暴露在创伤性身体或性虐待中的有害的高温引起的口腔面部疼痛的反应性增加。

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.