CAPSITE: Community Assessment of Pain and Sensitization in the Elderly

慢性疼痛影响着超过1亿的美国成年人和40%的65岁≥老年人，估计成本 每年5000亿至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长。慢性疼痛，无论解剖或诊断 与之相关的疾病(如背痛、偏头痛)是全球残疾的主要原因。有限的洞察 共同的机制是所有疼痛状况的基础，无论诊断如何，都是导致疼痛不足的原因。 管理选择，进而影响到阿片类药物的流行。治疗一种疼痛情况的医疗保健提供者 (例如，关节疼痛)通常不能控制身体其他部位的症状(例如，腹痛)，而患者 通常会从一个专家转到另一个专家那里。各种慢性重叠疼痛的共性研究 未选择疼痛条件的社区队列中的条件(COPC)可以提供对 慢性疼痛的原因和后果本身就是一种疾病。例如，疼痛中的神经生理学变化 疼痛敏感化(评估上行疼痛通路)和条件性疼痛调制等处理 (CPM)(评估下行疼痛调制)可能是所有慢性疼痛的共同机制。是这样的 知识将刺激针对所有类型疼痛的新疼痛管理方法的发展，无论 涉及解剖学或诊断学。尽管慢性疼痛给公共卫生造成了沉重的负担，但人们对此知之甚少 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，风险 养老院的入院情况和老年人的死亡率。我们建议在即将到来的 以社区为基础的老年人队列研究访问，没有选择任何疼痛主诉， 弗雷明翰心脏研究(N~1874年，平均年龄76岁，84%≥年龄70岁)。我们的目标是了解 COPC的流行病学，无论涉及的解剖或诊断，COPC随时间的演变， 疼痛处理过程中的神经生理学改变是COPC及其演变的危险因素，以及 COPC和改变老年人的疼痛处理。我们建议获取客观的定量感觉测试 (QST)疼痛敏感度和CPM的测量，这与疼痛严重程度和对 在实验环境中针对特定疼痛条件选择受试者进行治疗。然而，QST- 评估的神经生理改变可能是所有形式的慢性疼痛的共同潜在风险因素，以及 未选择的基于社区的老年人队列中的功能限制、制度化和死亡率 因为痛苦是未知的。我们将收集关于多种慢性疼痛状况、QST、自我报告和 基于表现的身体功能，以及在下一次计划的学习访问期间入住疗养院 作为两次后续评估，以获得纵向数据，并利用FHS正在进行的死亡率监测。 我们的工作将解决几个知识差距，所获得的见解最终可能有助于新的预防和 缓解慢性疼痛及其后果的治疗方法，而不考虑潜在的诊断。

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.