Adaptability and Resilience in Aging Adults (ARIAA)

 描述(由申请人提供)：越来越多的证据支持在老年人中存在失调的疼痛调制，这一效应可能会增加与年龄相关的慢性疼痛的风险。虽然持续性疼痛在老年人中很常见，但慢性下腰痛是这一人群残疾的主要原因，并导致心理社会和身体功能的严重损害。鉴于老年人疼痛治疗效果不佳的报道，改善这一队列中的疼痛管理至关重要。复原力是指在遭遇逆境后产生积极调整和适应的动态过程。复原力在健康相关功能中的好处是多方面的，最近的证据表明，复原力在促进对疼痛的适应性生理和情感反应方面发挥着重要作用。有鉴于此，利用积极的资源是增强疼痛适应的一个有希望的目标，考虑到这一群体中高冲击性疼痛的负担，对老年人来说尤其明显。因此，这个有指导的职业发展应用程序(K99/R00)的总体目标是填补这一知识空白，并表征韧性 患有慢性下腰痛的老年人的适应性疼痛调节能力的相关机制。目前应用的主要培训目标是：1)在老龄化的生物心理社会过程中建立一个全面的知识库，并加强对老年人的评估和治疗方面的培训；2)增加对与疼痛和复原力有关的心理社会和生物(即炎症、神经内分泌)标记物的了解和评估的知识；以及3)加强设计、实施和分析随机临床试验的培训。建议的研究分为两个阶段。研究1(K99阶段)将检查患有慢性下腰痛的老年人的弹性测量、炎症和神经内分泌活动的生物标记物以及疼痛调节能力之间的关系。增加对促进疼痛适应性的恢复力途径的了解和理解，将有助于在研究2(R00阶段)期间制定有针对性的恢复力干预措施。这一阶段将为研究干预对疼痛调节功能的影响以及生理和情感系统中疼痛诱发的恢复模式提供机会，并将确定以复原力为导向的干预是否对患有慢性下腰痛的老年人的心理社会和身体功能产生好处。拟议的职业发展计划扩展了私人助理先前关于慢性疼痛的情感调节和脆弱性机制的工作，并将开辟一条途径，以了解和研究改善老年人疼痛和残疾的复原力心理疗法。

 DESCRIPTION (provided by applicant): Growing evidence supports the presence of dysregulated pain modulation in older adults, an effect which may heighten age-associated risk for chronic pain. While persistent pain is common in older adults, chronic low back pain is the leading cause of disability in this population and results in significant impairments in psychosocial and physical functioning. Given reports of suboptimal treatment of pain in older adults, improvements in pain management in this cohort are of critical importance. Resilience is characterized as a dynamic process resulting in positive adjustment and adaptation after exposure to adversity. The benefits of resilience in health-related functioning are manifold, and recent evidence suggests that resilience plays an important role in fostering adaptive physiological and affective responses to pain. Given this, capitalizing on positive resources is a promising target for enhancing pain adaptation, and is especially salient to older adults given the burden of high-impact pain in this group. Therefore, the overall goal for this mentored career development application (K99/R00) is to fill this knowledge gap and characterize resilience mechanisms associated with adaptive pain modulatory capacity in older adults with chronic low back pain. Primary training goals for the current application are to: 1) develop a comprehensive knowledge base in biopsychosocial processes of aging and enhance training in the assessment and treatment of older adults; 2) increase knowledge in the understanding and assessment of psychosocial and biological (i.e., inflammatory, neuroendocrine) markers associated with pain and resilience; and 3) augment training in the design, implementation, and analysis of randomized clinical trials. The proposed study is delineated into two phases. Study 1 (K99 Phase) will examine associations among measures of resilience, biological markers of inflammation and neuroendocrine activity, and pain modulatory capacity in older adults with chronic low back pain. Increased knowledge and understanding of the resilience pathways that promote adaptability to pain will allow for the development of a targeted resilience intervention during Study 2 (R00 Phase). This phase will provide the opportunity for examining intervention effects on pain modulatory function and patterns of pain- evoked recovery in physiological and affective systems, and will establish whether a resilience-oriented intervention confers benefits in psychosocial and physical functioning in older adults with chronic low back pain. The proposed career development plan extends from the PI's prior work on affective regulation and mechanisms of vulnerability in chronic pain, and will forge a path towards understanding and investigating psychological therapies of resilience that improve pain and disability in older adults.