Development of Co-Morbid PTSD and Chronic Pain Among Inner-City Women

 描述（由申请人提供）：创伤后应激障碍和慢性疼痛是非常普遍的，每一个都与长期残疾和药物滥用有关，对个人和社会造成巨大的情感，功能和经济损失。创伤后应激障碍和慢性疼痛经常合并发病，重叠率在20%到70%之间，这是一个巨大的公共卫生问题。然而，我们对PTSD和慢性疼痛相互交织的机制的理解是有限的。PTSD/慢性疼痛共病的大多数研究是横断面的，并且集中于单一慢性疼痛病症，限制了因果推断和对其他慢性疼痛病症的普遍性。慢性疼痛也与药物滥用的高流行率有关。要了解创伤相关的创伤后应激障碍，以及弹性和脆弱性因素如何有助于从急性疼痛过渡到慢性疼痛和药物滥用的发展，需要前瞻性设计。这类研究对市中心的非裔美国妇女至关重要，她们更有可能经历创伤性压力和痛苦，但不太可能得到适当的治疗;这种现象可能导致更大的残疾和药物滥用风险。我们建议在6个月的前瞻性设计中检查3种与PTSD/慢性疼痛配对的发展和最初出现急性疼痛（不是由创伤事件引起）的人的药物滥用发展相关的模型。首先是主效应模型，其中基线时的PTSD症状水平将预测6个月时从急性疼痛转变为慢性疼痛和药物滥用发展的可能性。第二个是适度模型，其中基线脆弱性和弹性因素与PTSD症状相互作用，以预测6个月后发生慢性疼痛和药物滥用的可能性。第三个是中介模型，其中PTSD症状的基线水平与6个月后慢性疼痛和药物滥用的发展之间的关系由3个月时的脆弱性和弹性因素介导。将招募18-40岁因急性身体疼痛就诊于急诊室的市中心女性（N=600）。仅入组表现为急性盆腔/腹部、颈部/肩部或腰痛且无慢性疼痛史的女性。我们将评估创伤暴露，PTSD症状，疼痛敏感性，物质依赖和滥用，急性疼痛和心理社会恢复力和脆弱性因素在3个波（基线，3个月和6个月），并获得额外的电话评估疼痛强度和干扰在1，2，4和5个月。选择内城妇女是因为她们很有可能暴露于正在进行的创伤事件，并有机会阐明特别是内城少数民族妇女中涉及创伤后应激障碍/慢性疼痛配对的健康差异。共同发病的创伤后应激障碍，慢性疼痛和药物滥用所造成的公共卫生问题不能被夸大，特别是因为它影响了美国的健康差距。更好地了解创伤后应激障碍如何增加从急性疼痛转变为慢性疼痛和发展药物滥用的可能性，哪些因素有助于这些发展，哪些人可能最脆弱，将允许对准确识别的目标进行更及时的临床干预，以帮助预防这些在很大程度上难以治疗的疾病的发展。

 DESCRIPTION (provided by applicant): PTSD and chronic pain are highly prevalent and each is associated with long-term disability and substance abuse, exacting enormous emotional, functional, and financial tolls on individuals and society. PTSD and chronic pain are frequently co-morbid with overlap between 20% and 70%, representing an enormous public health problem. However, our understanding of the mechanisms by which PTSD and chronic pain become intertwined is limited. The majority of studies of the PTSD/chronic pain co-morbidity are cross- sectional, and focused on a single chronic pain condition, limiting causal inferences and generalizability to other chronic pain conditions. Chronic pain is also related to a high prevalence of substance abuse. To understand how trauma-related PTSD, and resilience and vulnerability factors contribute to the transition from acute to chronic pain and development of substance abuse requires prospective designs. Such research is vital among inner-city African American women, who are more likely to experience traumatic stress and pain, but are less likely to be treated appropriately; a phenomenon perhaps leading to greater risk for disability and substance abuse. We propose to examine 3 models related to the development of PTSD/chronic pain pairing and development of substance abuse in people initially presenting with acute pain (not caused by a traumatic event) in a 6-month prospective design. First is the Main Effects Model in which the level of PTSD symptoms at baseline will predict the likelihood of a transition from acute to chronic pain and development of substance abuse at 6 months. Second is the Moderation Model in which baseline vulnerability and resilience factors interact with PTSD symptoms to predict the likelihood of developing chronic pain and substance abuse 6 months later. Third is the Mediator Model in which relationships between baseline levels of PTSD symptoms and the development of chronic pain and substance abuse 6 months later are mediated by vulnerability and resilience factors at 3 months. Inner-city women (N=600) presenting to an Emergency Department with a complaint of acute bodily pain, ages 18-40 yrs, will be recruited. Only women presenting with acute pelvic/abdominal, neck/shoulder or low back pain, and who do not have a chronic pain history will be enrolled. We will assess trauma exposure, PTSD symptoms, pain sensitivity, substance dependence and abuse, acute pain and psychosocial resilience and vulnerability factors across 3 waves (baseline, 3- and 6-months), and obtain additional phone assessment of pain intensity and interference at 1-, 2-, 4-, and 5-months. Inner-city women were chosen because of their high likelihood of exposure to ongoing traumatic events and the opportunity to illuminate a health disparity involving the PTSD/chronic pain pairing among inner-city minority women in particular. The public health problem posed by co-morbid PTSD, chronic pain and substance abuse cannot be overstated, particularly as it impacts health disparities in the US. Greater understanding of how PTSD may increase the likelihood of transitioning from acute to chronic pain and developing substance abuse, which factors contribute to these developments, and which people may be most vulnerable will allow more timely clinical interventions on accurately identified targets to help forestall the development of these largely intractable conditions.