Prospective Study of Racial and Ethnic Disparities in Chronic Pain and Pain Burden

 描述(申请人提供)：慢性疼痛对种族和少数民族造成不成比例的公共卫生负担。在接受疼痛治疗方面存在很大的不平等 非裔美国人和拉丁裔相对于他们的非拉丁裔白人同行。数据表明，这些少数群体的成员不仅更容易患上慢性疼痛，而且这种疼痛伴随着更大的疼痛负担，即更大的痛苦，更差的生活质量， 和更严重的功能障碍。在理解种族和族裔为什么会带来痛苦不平等以及如何最好地解决这些差异方面只取得了一定的进展。拟议研究的长期目标是为减少或彻底消除种族和民族痛苦差异做出贡献。这项计划中的研究的近期目标是从过多的假设解释中确定一小部分最有希望的干预目标，以减少或消除种族/民族疼痛差异。据我们所知，这项计划中的研究将是有史以来第一次对导致从急性疼痛向慢性疼痛过渡的种族和民族差异的因素进行前瞻性检查。这项研究还将首次在需要住院的严重身体损伤后康复的重要背景下调查这些问题。在这项拟议的研究中，900名严重身体损伤的成年幸存者的样本将在加利福尼亚州洛杉矶和宾夕法尼亚州费城的大型创伤中心住院期间招募，其中包括比例大致相同的非裔美国人、拉丁裔和非拉丁裔白人。访谈将在住院期间以及3个月、12个月的随访中进行。医疗记录将提供可能影响疼痛进程的伤害严重程度和医院内药物使用的信息。具体目标是(1)确定非裔美国人和拉丁裔身体损伤幸存者在受伤后是否比他们的非拉丁裔白人幸存者经历更严重的疼痛；(2)确定非洲裔和拉丁裔受伤幸存者是否比他们的非拉丁裔白人幸存者经历更大的疼痛负担；(3)确定非洲裔和拉丁裔在疼痛严重程度或疼痛负担方面的差异是否可以与一小群有前途的候选人联系起来，作为旨在减少或消除疼痛结果差异的干预措施的目标；以及(4)确定高危少数群体的疼痛结果是否可以与一小部分有希望的候选人群联系起来，作为针对人群的干预措施的目标，以降低疼痛严重程度和疼痛负担，无论这些候选人群是否导致组间疼痛差异。从拟议的研究中获得的知识有很大潜力加快旨在消除种族和族裔痛苦差距的努力，为缩小痛苦差距的预防和干预努力确定有希望的目标。

 DESCRIPTION (provided by applicant): Chronic pain poses a disproportionate public health burden on racial and ethnic minorities. Substantial inequities exist in the pain treatment received by African-Americans and Latinos relative to their non-Latino White counterparts. Data suggest that members of these minority groups are not only more likely to develop chronic pain but also to have this pain accompanied by greater pain burden, i.e., greater suffering, poorer life quality, and worse functional impairment. Only modest headway has been made in understanding why race and ethnicity confer pain inequities and how best to address these disparities. The long-term objective of the proposed research is to contribute to the reduction or outright elimination o racial and ethnic pain disparities. The near-term goal of the planned research is to identify a small set of the most promising intervention targets, from among the plethora of posited explanations, for reducing or eliminating racial/ethnic pain disparities. The planned study would be, to our knowledge, the first ever prospective examination of factors posited to underlie racial and ethnic disparities in the transition from acute to chronic pain. The study would also be the first to investigate these issues in the important context of recovery following serious physical injury requiring hospitalization. For the proposed research, a sample of 900 adult survivors of serious physical injury, comprised of roughly equal proportions of African-Americans, Latinos, and non-Latino Whites, will be recruited during hospitalization from large trauma centers in Los Angeles, CA and Philadelphia, PA. Interviews will be conducted during hospitalization and at 3-, and 12-month follow-up. Medical records will provide information on injury severity and medication use in-hospital which may influence the course of pain. The specific aims are (1) to determine whether African-American and Latino physical injury survivors experience more severe pain following injury relative to their non-Latino White counterparts; (2) to determine whether African-American and Latino injury survivors experience greater pain burden relative to their non- Latino White counterparts; (3) to determine whether African-American and Latino differences in pain severity or pain burden can be linked to a small set of promising candidates to serve as targets for interventions aimed at reduction or elimination of pain outcome disparities; and (4) To determine whether pain outcomes in at-risk minority groups can be linked to a small set of promising candidates to serve as targets for group-tailored interventions to reduce pain severity and pain burden irrespective of whether these candidates contribute to between-group pain disparities. The knowledge gained from the proposed research has high potential to accelerate efforts aimed at eliminating racial and ethnic pain disparities by identifying promising targets for prevention and intervention efforts to close the pain gap.