CAPSITE: Community Assessment of Pain and Sensitization in the Elderly

慢性疼痛影响超过1亿美国成年人和>40%的年龄≥65岁的老年人，估计费用 每年超过5000亿到1万亿美元。老年人患多种疼痛疾病的风险增加， 在慢性疼痛的负面影响下活得更久。慢性疼痛，无论解剖结构或诊断 涉及（例如，背痛、偏头痛）是全球残疾的主要原因。对是否存在 所有疼痛状况的共同机制，无论诊断如何，都导致了疼痛不足 管理选择，反过来，阿片类药物的流行。治疗一种疼痛状况的卫生保健提供者 (e.g.,关节痛）通常不能控制身体其它部位的症状（例如，腹痛）和患者 经常从一个专家转到另一个专家。研究各种慢性重叠疼痛的共性 在基于社区的队列研究中，疼痛状况（COPC）可以为以下方面提供新的见解 慢性疼痛作为一种疾病本身的原因和后果。例如，疼痛的神经生理学改变 疼痛敏感化（评估上行疼痛通路）和条件性疼痛调节等处理 (CPM)（评估下行疼痛调节）可能是所有慢性疼痛的共同机制。等 知识将刺激开发新的疼痛管理方法，用于所有类型的疼痛， 涉及解剖或诊断。尽管慢性疼痛的公共卫生负担很大，但人们对慢性疼痛知之甚少。 COPC在老年人中的流行病学和演变，以及COPC对身体功能的影响， 养老院入院率和老年人死亡率。我们建议在即将到来的 对一个完全特征化的以社区为基础的老年人队列进行研究访问， FHS研究（N~1874，平均年龄76，84% ≥ 70岁）。我们的目标是了解 COPC的流行病学，无论涉及解剖或诊断，COPC随时间的演变， 疼痛过程的神经生理学改变是COPC及其演变的危险因素， COPC和改变老年人的疼痛处理。我们建议获得客观的定量感觉测试 (QST)疼痛敏感性和CPM的测量，这与疼痛的严重程度和对 在针对特定疼痛状况选择的受试者的实验环境中进行治疗。然而，无论QST- 评估的神经生理学改变可能是所有形式慢性疼痛的常见潜在风险因素， 功能限制，机构化和死亡率在一个以社区为基础的老年人队列中 疼痛是未知的。我们将收集有关多种慢性疼痛状况、QST、自我报告和 基于表现的身体功能，以及下一次计划研究访视期间的疗养院入院情况， 作为两个后续评估，以获得纵向数据，并利用正在进行的FHS死亡率监测。 我们的工作将解决几个知识差距，获得的见解可能最终促进新的预防和 治疗方法，以缓解慢性疼痛及其后果，无论潜在的诊断。

Chronic pain affects over 100 million American adults and >40% of older adults age ≥65, with estimated costs of >$500 billion to $1 trillion annually. Older adults are at increased risk of having multiple painful conditions and are living longer with the negative impacts of chronic pain. Chronic pain, regardless of anatomy or diagnosis involved (e.g., back pain, migraine), is the leading cause of disability worldwide. Limited insights into whether common mechanisms underlie all pain conditions, regardless of diagnosis, has contributed to inadequate pain management options, and in turn, to the opioid epidemic. Health care providers who treat one pain condition (e.g., joint pain) typically do not manage symptoms in other parts of the body (e.g., abdominal pain), and patients are often referred from one specialist to another. Studying commonalities of various chronic overlapping pain conditions (COPC) in community-based cohorts unselected for pain conditions can provide novel insights into causes and consequences of chronic pain as a disease itself. For example, neurophysiologic alterations in pain processing such as pain sensitization (assessing ascending pain pathways) and conditioned pain modulation (CPM) (assessing descending pain modulation) may be common mechanisms underlying all chronic pain. Such knowledge would spur development of novel pain management approaches for all types of pain regardless of anatomy or diagnosis involved. Despite the substantial public health burden of chronic pain, little is known about the epidemiology and evolution of COPC in older adults, nor of the impact of COPC on physical function, risk of nursing home admission, and mortality in older adults. We propose to evaluate chronic pain in the upcoming study visit of a thoroughly-characterized community-based older adult cohort unselected for any pain complaints, the Framingham Heart Study (FHS) (N~1874, mean age 76, 84% ≥age 70). We aim to understand the epidemiology of COPC, regardless of anatomy or diagnosis involved, the evolution of COPC over time, neurophysiologic alterations in pain processing as risk factors for COPC and its evolution, and consequences of COPC and altered pain processing in older adults. We propose acquiring objective quantitative sensory testing (QST) measures of pain sensitization and CPM, which are associated with pain severity and response to treatment in experimental settings of subjects selected for particular pain conditions. However, whether QST- assessed neurophysiologic alterations may be common underlying risk factors for all forms of chronic pain, and for functional limitations, institutionalization, and mortality in a community-based cohort of older adults unselected for pain is unknown. We will collect data regarding a multitude of chronic pain conditions, QST, self-report and performance-based physical function, and nursing home admissions during the next planned study visit, as well as two follow-up assessments to obtain longitudinal data, and leverage the ongoing FHS surveillance of mortality. Our work will address several knowledge gaps, and insights gained may ultimately facilitate new preventive and therapeutic approaches to relieving chronic pain and its consequences, regardless of underlying diagnosis.