Catastrophizing and Pain in Rheumatoid Arthritis

描述（由申请人提供）： 候选人的长期职业目标与理解心理社会因素对疼痛相关结果影响的机制有关。这个职业发展奖（K23）将为候选人提供必要的培训，以发展这项研究计划。该K23的具体培训目标包括开发疼痛的心理神经免疫学和体内评估方法的专业知识。拟议的研究计划探讨类风湿性关节炎（RA）疼痛的生物心理社会方面，这是一种慢性疼痛性疾病，具有良好的心理社会和生物成分。在影响疼痛体验的认知和情感变量中，最重要的是灾难化。虽然灾难化已被确定为慢性疼痛和残疾的重要预测因子，但对其产生有害影响的机制知之甚少。目前的理论表明，灾难化通过以下两种途径运作：（1）招募社会反应，减少疼痛的自我管理，（2）对疼痛调节途径和其他神经生理系统的直接负面影响。了解灾难化的作用机制将有助于制定旨在减少其影响的干预措施，改善慢性疼痛患者的健康相关生活质量。拟议的研究计划涉及类风湿关节炎患者的平行研究;一项前瞻性观察性研究将检查灾难化的社会维度，而一项基于实验室的研究将同时评估其心理生理学和免疫学后果。在慢性疼痛流行的背景下，进一步研究灾难化的作用机制变得越来越重要。候选人对拟议项目的目标是了解灾难化影响疼痛相关结果的途径，以完善疼痛的生物心理社会模型，并促进慢性关节炎疼痛的心理社会干预的发展或增强。

DESCRIPTION (provided by applicant): The candidate's long-term career objectives relate to understanding the mechanisms underpinning psychosocial factors' impact on pain-related outcomes. This Career Development Award (K23) will provide the candidate the necessary training to develop this research program. Specific training aims of this K23 include development of expertise in the psychoneuroimmunology of pain and in-vivo assessment methods. The proposed research plan examines biopsychosocial aspects of pain in rheumatoid arthritis (RA), a chronically painful disorder with well-documented psychosocial and biological components. Among the most consistently important of the cognitive and affective variables impacting on the experience of pain is catastrophizing. While catastrophizing has been identified as an important predictor of chronic pain and disability, little is known regarding the mechanisms by which it produces its deleterious effects. Current theory suggests that 2 of the pathways through which catastrophizing operates are: (1) recruitment of social responses that reduce self-management of pain, and (2) direct negative effects on pain-regulatory pathways and other neurophysiological systems. Understanding catastrophizing's mechanisms of action will assist in the development of interventions designed to reduce its impact, improving the health-related quality of life of individuals with chronic pain. The proposed research plan involves parallel studies in patients with RA; a prospective observational study will examine the social dimensions of catastrophizing while a laboratory- based study will concurrently evaluate its psychophysiological and immunological consequences. The need for further research into catastrophizing's mechanisms of action is increasingly important in the context of an epidemic of chronic pain. The candidate's goal for the proposed project is to understand the pathways by which catastrophizing impacts pain-related outcomes in order to refine biopsychosocial models of pain and facilitate the development or enhancement of psychosocial interventions for chronic arthritis pain.