Physiological and Emotional Reactivity to Pain after Physical and Sexual Abuse

身体和性虐待后对疼痛的生理和情感反应

• 批准号: 8214456
• 负责人: KARIN N. WESTLUND-HIGH
• 金额: $ 13.74万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-23 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8214456
• 关键词: Anger; Area; Arousal; Attention; Autonomic nervous system; Basic Science; Behavior Therapy; Behavioral; Biological; Biological Markers; Breathing; Carbon Dioxide; Cardiovascular system; Characteristics; Chronic; Chronic Post Traumatic Stress Disorder; Clinical; Clinical Research; Clinical Sciences; Communication; Communities; DSM-IV; Dentistry; Emotional; Emotions; Event; Exposure to; Faculty; Future; Goals; Hand; Heart Rate; Heat Stress Disorders; Heating; Hormonal; Human; Hydrocortisone; Impairment; Individual; Informal Social Control; Instruction; Interpersonal Violence; Intervention; Kentucky; Laboratories; Laboratory Finding; Lead; Link; Long-Term Effects; Mandible; Measures; Mediating; Menstrual cycle; Mental Depression; Mentors; Methods; Nervous System Physiology; Neurologic; Occupational; Oral health; Orofacial Pain; Outcome; Pain; Pain Clinics; Pain Research; Participant; Patient Self-Report; Patients; Pattern; Persons; Physiological; Pilot Projects; Post-Traumatic Stress Disorders; Procedures; Protocols documentation; Psychophysiology; Questionnaires; Recording of previous events; Recruitment Activity; Research; Research Personnel; Respiration; Scientist; Seasons; Sexual abuse; Shelter facility; Side; Sleep; Staging; Stimulus; Structure; Symptoms; System; Techniques; Testing; Training; Translational Research; Trauma; Trigeminal Neuralgia; Trigeminal System; Trigeminal nerve structure; Universities; Woman; career; chronic pain; college; design; experience; glucose metabolism; heart rate variability; hypothalamic-pituitary-adrenal axis; improved; indexing; orofacial; physical abuse; psychologic; respiratory; response; skills; skills training; social; stressor; translational study

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.

描述（由申请人提供）：该提案详细介绍了肯塔基大学牙科学院经验丰富的疼痛研究科学家与经验丰富的临床行为科学家作为导师的短期职业提升计划。为教师级别候选人提出的培训机会包括：(1) 临床和转化科学 (CTS) 的正式证书培训和 (2) 临床口面部疼痛研究的指导培训。慢性疼痛是一种长期持续但记录较少的结果，与遭受人际暴力后的创伤后应激障碍 (PTSD) 相关。这项受指导的试点研究将在当地社区庇护所有过身体虐待和/或性虐待史的女性中进行。导师查尔斯·卡尔森博士和他的同事的实验室研究发现，创伤后应激障碍 (PTSD) 与女性慢性口面部疼痛之间存在联系。这些慢性疼痛患者同时发生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干预策略的适当目标。最近的证据表明，控制呼吸速率和模式可以恢复 HRV 的增加。卡尔森博士开发了一种呼吸自我调节的个人技能训练方法，可能有助于抵消因遭受创伤事件而引起的持久生理变化。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事件而引发的痛苦热应激的生理反应改变。目标 1：评估经历过身体虐待或性虐待的有/无 PTSD 症状的参与者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的生理激活和情绪反应进行评估。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。基线生理测量包括心率、呼气末二氧化碳 (ETCO2) 和呼吸频率。目标 2：研究对身体压力源（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。将向口面部区域施加由单侧间歇性疼痛热刺激组成的物理应激源，同时继续进行生理记录（心率、ETCO2、呼吸频率）。在缓慢膈式呼吸干预指导后，将重复该程序，该干预将介绍给使用随机数字表随机选择的一半参与者。本次培训的长期目标是让候选人做好准备，在接受正式 CTS 培训并参与指导性试点研究后，设计、执行和分析慢性口面部疼痛患者的临床转化研究，以了解身体/性虐待后 PTSD 的不良生理结果。 公共卫生相关性：虐待造成的严重心理创伤会产生明显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。呼吸自我调节方面的个人技能训练将用于抵消持续的生理变化以及对因遭受创伤性身体虐待或性虐待而引发的有害热引起的口面部疼痛的反应性增加。