Neurobiological and psychosocial risk for transition from acute to chronic musculoskeletal pain in adolescence

项目摘要 慢性肌肉骨骼(MSK)疼痛问题在青春期急剧增加，影响广泛 以及高昂的直接和间接医疗成本。不幸的是，患有慢性MSK疼痛的青少年很可能 成为患有慢性MSK疼痛的成年人，也会遭受高度的负面后果，包括 残疾、生活质量差和心理社会功能差。在青春期发育期，急性 MSK疼痛主诉(最常见的是脊柱、膝盖、脚或脚踝疼痛)占很大一部分 医生和最近的研究估计，这些年轻人中约有30%-35%的人从急性疼痛过渡到 慢性疼痛状态。然而，从急性疼痛状态向慢性疼痛状态转变的潜在机制很差。 了解，特别是在青少年。虽然有许多已知的生物、心理和社会风险因素会导致 慢性疼痛的发展，更好地从机制上理解急性和慢性疼痛之间的过渡 各国对开发新的疗法和预防性干预措施至关重要，旨在阻止 在它变得无效和昂贵之前，慢性疼痛。这项拟议的研究将检查两个关键的神经生物学 以及导致青少年慢性MSK疼痛发展的生物、心理和社会风险因素。致我们的 知识，这将是第一次在接受治疗的青年样本中进行的神经成像研究 治疗急性MSK疼痛。捕捉患有MSK疼痛的寻求治疗的青少年，并跟踪这些青少年 将提供有关过渡的候选机制和风险的新信息 从急性到慢性疼痛状态。使用静息状态和基于任务的功能和结构磁 磁共振成像，以及全面的自我和代理报告测量生物心理社会病史和 功能，我们将确定与急性MSK疼痛相关的独立多模式神经生物学成分 并检查与慢性疼痛的理论基础的生物心理社会风险途径的相关性 一系列环境因素的背景。然后我们将前瞻性地研究这些神经生物学和 生物心理社会风险途径(疼痛处理、情绪和疼痛相关认知)与疼痛有关。 使用并行过程潜伏期曲线建模，以及 追溯确定其他 州) 神经生物学表型(不包括与急性MSK疼痛相关的表型 这将那些表现出疼痛持续性的人与那些症状缓解的人区分开来。 参与者将包括11-17岁的青少年，n=200名患有急性MSK疼痛的青少年和n=80岁的样本。 性别匹配的无痛控制，以及参与的父母。这些青少年将被跟踪调查 另外三次(在一年内每3个月检查一次)以检查疼痛持续性和疼痛相关 随着时间的推移会产生影响。在这一发展转型期间确定风险的机制和调节因素将 为旨在降低青少年慢性疼痛风险的干预措施提供重要信息。

Project Summary Chronic musculoskeletal (MSK) pain problems increase dramatically in the adolescent years, with wide impact and high direct and indirect healthcare costs. Unfortunately, adolescents with chronic MSK pain are likely to become adults with chronic MSK pain, and also suffer from high levels of negative consequences, including disability, poor quality of life, and poor psychosocial functioning. In the adolescent developmental period, acute MSK pain complaints (most commonly spine, knee, and foot or ankle pain) account for a large portion of physician visits, and recent studies estimate that about 30-35% of these youth transition from acute pain to a chronic pain state. However, mechanisms underlying the transition from acute to chronic pain states are poorly understood, particularly in adolescents. While there are a number of known biopsychosocial risk factors for the development of chronic pain, better mechanistic understanding of transition between acute and chronic pain states is crucial for the development of novel therapeutics and preventative interventions designed to stop chronic pain before it becomes disabling and costly. The proposed study will examine both key neurobiological and biopsychosocial risk factors that contribute to the development of chronic MSK pain in adolescents. To our knowledge, this would be the first neuroimaging study conducted in a sample of youth presenting for treatment for acute MSK pain. Capturing treatment-seeking adolescents with MSK pain and following these youth over the course of the following year, will provide novel information about candidate mechanisms and risk for the transition from acute to chronic pain states. Using resting state and task-based functional and structural magnetic resonance imaging, alongside comprehensive self and proxy report measures of biopsychosocial history and function, we will identify independent multimodal neurobiological components associated with acute MSK pain and examine associations with theoretically-grounded biopsychosocial risk pathways for chronic pain in the context of a host of environmental factors. We will then prospectively examine how these neurobiological and biopsychosocial risk pathways (pain processing, mood, and pain related cognition) are related to pain persistence and pain-related impact over time using parallel process latent growth curve modeling, as well as retrospectively identify additional state) neurobiological phenotypes (beyond those associated with the acute MSK pain that differentiate individuals demonstrating pain persistence from those with symptom remission. Participants will include adolescents, ages 11-17, with n=200 acute MSK pain and a sample of n=80 age- and sex-matched pain-free controls, as well as a participating parent. These adolescents will be followed an additional three times (every 3 months over a 1 year period) to examine pain persistence and pain-related impacts over time. Determining mechanisms and moderators of risk during this developmental transition will provide critical information for interventions aimed at reducing risk for chronic pain in youth.