High Impact Chronic Pain and UK Biobank: presentation, transitions and targets for intervention

背景近一半的英国成年人肌肉或关节疼痛持续时间超过三个月(慢性疼痛)。虽然大多数人都能很好地管理，但大约25%的人有痛苦，这种痛苦对他们的生活产生了深远的负面影响，导致残疾、痛苦、社会孤立和高度的医疗需求。慢性疼痛有很多种不同的表现形式，目前还不清楚为什么有些人会经历如此强烈的慢性疼痛，而另一些人则没有。我们也不知道为什么有些人会改善，而另一些人则会从疼痛中感受到持续甚至不断增加的影响。研究的目的我们的目的是找出高冲击性慢性疼痛的可能原因(或“风险因素”)。这将为设计或在自我护理或治疗选项之间做出选择提供信息，这些选项可能更有效地满足人们的个人需求。针对特定危险因素的早期护理或支持也可能有助于防止高影响慢性疼痛的发生。具体地说，我们计划使用一项大型的、全国性的老年人研究(英国生物库)的现有数据。确定具有不同模式的高影响慢性疼痛的人群，他们可能有不同的结果和不同的护理需求2。了解为什么高冲击性慢性疼痛对某些人的影响比其他人更大，以及为什么这种情况会随着时间的推移而改变，重点放在以下方面的影响：a.心理因素，包括情绪、注意力、记忆力、解决问题的能力；b.人们生活中可能在不同时间发生的创伤或创伤性事件(例如，骨折、丧亲、突发疾病)3.确定可以减少这些风险因素对慢性疼痛患者的影响的自我护理或治疗方案。设计和方法我们将使用英国生物库的数据，其中包括英国50万人的健康信息，这些人在2006-2010年间开始收集数据时年龄在40-69岁之间。2019年，超过173,000名参与者完成了关于慢性疼痛的性质和影响的问卷调查。第二份疼痛问卷将于2023年发送给参与者。研究团队将与患者合作伙伴共同研究以下三个工作包：(1)我们将使用最先进的统计和人工智能方法来识别具有不同慢性疼痛模式的亚组，并描述其对日常活动、情绪和医疗保健使用的影响。(2)我们将使用15年以上收集的问卷和医疗记录中的数据，调查可能解释慢性疼痛影响随时间变化的因素的作用，包括(A)情绪、注意力、记忆力、解决问题和(B)身体或心理创伤。(3)根据(2)的结果，我们将确定可以有效地针对自我护理或治疗的因素。然后，我们将估计如果这种干预措施成功地提供给慢性疼痛患者，可以获得多少好处。患者和公共调查研究问题由患者伴侣提供，他们分享了他们的生活故事，并提出了可能解释慢性疼痛发展的因素，以及影响如何随着时间的推移而改变。他们将继续参与界定和确定分析因素的优先次序；审查干预措施；解释结果；制定关键信息和传播调查结果。沟通发现我们将与患者合作伙伴和临床顾问合作-在科学期刊和(国际)疼痛会议期间发布结果-与其他研究团队和APDP中的PPIE网络共享我们的发现，并与英国生物库-参与我们现有的网络，包括VS关节炎、公共卫生英格兰、NHS合作伙伴、研究资助者-设计信息图表、可视动画或YouTube视频，以适合广大受众的方式交流关键发现-举办网络研讨会，讨论发现和影响

BACKGROUNDNearly half of UK adults have pain in their muscles or joints lasting longer than three months (chronic pain). While most people manage well, about 25% of people have pain that has far-reaching, negative impacts on their lives, leading to disability, distress, social isolation, and high healthcare needs. Chronic pain presents in many different ways, and it is not clear why some people experience such 'high impact chronic pain' whereas others don't. We also don't know yet why some people improve, whereas others experience ongoing or even increasing impact from their pain. AIMS OF THE RESEARCHWe aim to find out the possible causes (or 'risk factors') of high impact chronic pain. This will inform the design or choice between selfcare or treatment options that may more effectively address people's individual needs. Early care or support that target specific risk factors may also help prevent the onset of high impact chronic pain. Specifically, we plan to use existing data from a large, national study of older adults (UK Biobank) to1. Identify groups of people with distinct patterns of high impact chronic pain who may have different outcomes and different care needs2. Understand the reasons why high impact chronic pain affects some more than others, and why this can change over time, focusing on the influence of: a. psychological factors, including mood, attention, memory, ability to problem-solve b. trauma or traumatic events that may occur at different times in people's lives (e.g., fracture, bereavement, sudden illness)3. Identify selfcare or treatment options that can reduce the influence of these risk factors for people with chronic pain. DESIGN AND METHODSWe will use data from UK Biobank, which includes health information from 500,000 people in the UK, who were aged 40-69 years when data collection started in 2006-2010. A questonnaire on the nature and impact of chronic pain was completed by over 173,000 participants in 2019. A second pain questionnaire will be sent to participants in 2023. The study team will work together with patient partners on the following three workpackages:(1) We will use state-of-the art statistical and artificial intelligence methods to identify subgroups with distinct patterns of chronic pain, and describe its impact on daily activity, mood, and healthcare use. (2) We will use data from questionnaires and healthcare records collected over a period of more than 15 years, to investigate the role of factors that may explain changes over time in the impact of chronic pain, including (a) mood, attention, memory, problem-solving, and (b) physical or psychological trauma. (3) Based on the results from (2) we will identify factors that can be effectively targeted by selfcare or treatment. We will then estimate how much benefit could be achieved if such interventions would successfully be offered to people with chronic pain. PATIENT AND PUBLIC INVOLVEMENTResearch questions have been informed by patient partners, who shared their life stories, and suggested factors that may explain the development of chronic pain, and how impact can change over time. They will continue to be involved in defining and prioritising factors for analysis; reviewing interventions; interpreting results; formulating key messages and dissemination of findings. COMMUNICATING FINDINGSWe will work together with patient partners and clinical advisors to- Publish results in scientific journals and during (international) pain conferences- Share our findings with other research teams and the PPIE network in APDP, and with UK Biobank - Engage with our existing networks, including Versus Arthritis, Public Health England, NHS partners, research funders - Design infographics, visual animations, or YouTube videos to communicate key findings in a way that is suitable for a wide audience- Hold webinars to discuss findings and implications