Influence of PTSD Symptoms on Chronic Pain Development after Sexual Assault

描述(由申请者提供)：每年有超过10万名美国女性在性侵犯(SA)后寻求紧急医疗护理。大多数妇女在最初的紧急评估后没有返回接受与SA有关的进一步护理。因此，紧急护理访问是一个独特的机会，可以确定沙门氏菌幸存者，进行预防性干预，以改善恢复情况。横断面研究表明，许多SA幸存者报告了慢性肌肉骨骼疼痛(MSP)，并与严重的痛苦和不良的健康结局有关。然而，目前还没有对SA后慢性MSP预后进行评估的前瞻性研究，因此SA和慢性MSP之间的病因学联系尚未建立。在最近的一项前瞻性先导研究中(n=83)，研究人员发现，登记的女性SA幸存者中有41%患上了慢性中度或重度MSP。从所有参与试点研究的女性收集的初始疼痛评分显示，超过一半的慢性MSP高危患者同意并参加了试点研究。此外，收集的数据表明， 参与先导研究的女性SA幸存者与愿意参加预防性干预试验的SA幸存者是同一组。然而，目前还没有关于影响SA术后MSP从急性向慢性转变的关键因素的信息，以便为此类试验的设计提供信息。现有证据表明，创伤后应激障碍(PTSD)症状可能是SA后MSP从急性向慢性转变的关键因素。创伤后应激障碍症状群被发现在其他创伤人群中调节从急性到慢性MSP的转变，研究人员的试点数据支持研究人群中的这些关系。重要的是，尽管有证据表明PTSD症状是导致SA后MSP慢性发展的关键因素，但现有数据也表明，并不是所有急性MSP患者都会出现PTSD症状，也不是所有PTSD症状患者都会发展为慢性MSP。这表明，重要的个体差异缓和了这些关系。可获得的证据和研究人员的试点数据表明，影响 下丘脑-垂体-肾上腺(HPA)和儿茶酚胺能系统的功能构成了这种重要的个体差异。研究人员建议对女性SA幸存者(n=900)进行前瞻性队列研究，在SA后1周、6周、6个月和12个月进行评估。包括验证性因素分析和结构方程模型在内的方法论方法将被用来检验以下假设：慢性MSP在研究人群中很常见，创伤后应激障碍症状群调节SA后急性和慢性MSP之间的关系，以及拟议的遗传因素调节这些关系。这项开创性的研究结果将推广到大量女性SA幸存者，她们经历了SA MSP后的高负担，并将为这一研究不足的人群制定预防性干预措施提供参考。

DESCRIPTION (provided by applicant): Each year more than 100,000 US women seek emergency medical care after sexual assault (SA). Most women do not return for/receive further care related to SA after initial emergency evaluation. Thus the emergency care visit represents a unique opportunity to identify SA survivors for preventive interventions to improve recovery. Cross-sectional studies indicate that chronic musculoskeletal pain (MSP) is reported by many SA survivors and is associated with substantial suffering and poor health outcomes. However, no prospective studies evaluating chronic MSP outcomes after SA have been performed, and therefore a firm etiologic link between SA and chronic MSP has not been established. In a recent prospective pilot study (n = 83), the investigators found that 41% of women SA survivors enrolled developed chronic moderate or severe MSP. Initial pain scores collected from all women approached for pilot study participation showed that more than half of those at high risk of chronic MSP consented and enrolled in the pilot study. In addition, data collected indicate that women SA survivors who participated in the pilot study are the same group of SA survivors who would be willing to participate in preventive intervention trials. However, currently no informatio exists regarding key factors that influence the transition from acute to chronic post-SA MSP to inform the design of such trials. Available evidence suggests that posttraumatic stress disorder (PTSD) symptoms may be key factors mediating the transition from acute to chronic post-SA MSP. PTSD symptom clusters have been found to mediate the transition from acute to chronic MSP in other trauma populations, and the investigator's pilot data support these relationships in the study population. Importantly, despite evidence that PTSD symptoms are key factors mediating chronic post-SA MSP development, available data also indicate that not all individuals with acute MSP develop PTSD symptoms, and not all individuals with PTSD symptoms develop chronic MSP. This suggests that important individual differences moderate these relationships. Available evidence, and the investigator's pilot data, suggests that genetic variants affecting the function of hypothalamic-pituitary-adrenal (HPA) and catecholaminergic systems constitute such important individual differences. The investigators propose a prospective cohort study of women SA survivors (n = 900) evaluated 1 week, 6 weeks, 6 months, and 12 months after SA. A methodological approach including Confirmatory Factor Analyses and Structural Equation Modeling will be used to test the hypotheses that chronic MSP is common in the study population, that PTSD symptom clusters mediate the relationship between acute and chronic MSP after SA, and that the proposed genetic factors moderate these relationships. Results of this groundbreaking study will generalize to a large population of women SA survivors who experience a high burden of chronic post-SA MSP, and will inform the development of preventive interventions for this understudied population.