Long-Term Developmental and Health Impact of Adolescent Chronic Pain

项目总结 慢性疼痛的发生率在青春期急剧上升，并导致改变 规范的发展轨迹，反映在失学、退出社会活动、家庭 功能障碍，过度依赖父母。虽然有强有力的经验支持最初和短期- 青少年慢性疼痛的长期影响，对生命过程的后果知之甚少。确定 青春期疼痛的长期影响对于向目标提供预防性干预、减轻 痛苦，并促进成年后的积极适应。本项目的具体目标是：(1)确定 青春期慢性疼痛对青春期发育和健康结局的长期影响 (研究1)和(2)确定个体内(如焦虑)和个体间(如家庭功能) 青春期的脆弱性放大了不良后果的风险(研究2)。我们将采取一项综合性的 检查青壮年关键过渡结果的方法：(1)教育成就，(2) 职业成就，(3)同伴和恋爱关系，(4)独立生活，(5)一般健康状况， (6)慢性疼痛症状；(7)向成人医疗过渡。项目目标将会实现。 通过在申请人的两年研究金期间完成两个补充研究。研究1是 全国青少年至成人健康纵向调查的二次数据分析 青春期慢性疼痛(第一波和第二波)是导致青少年不良结局的风险因素(第三波)。 研究2涉及对140名年轻人(18-25岁)的新的跟踪数据收集，这些人在青春期 (11-17岁)，参加了先前由美国国立卫生研究院资助的互联网传递疼痛的随机对照试验 管理课程。我们将利用先前试验中对疼痛的基线评估数据，并 个人内部和人际之间的脆弱性，以预测当前的健康和青年时期的发展。在……里面 结合起来，这些研究代表着一个独特的机会，可以确定青少年在多大程度上患有 慢性疼痛面临长期逆境的风险，并确定可能影响穷人的早期脆弱因素 结果。两年制博士后计划开展的研究和相应的培训活动 研究员奖将允许申请者在以发展为基础的儿科疼痛研究方面积累专业知识。 和先进的纵向队列设计和分析。培训还将侧重于赠款撰写和学术研究。 疼痛领域的生产力。获得这一Ruth L.Kirschstein国家研究服务奖将 支持申请者发展必要的科学和领导技能，以建立独立的 关于儿科疼痛的生命过程后果的研究生涯和一个很有前途的新科学计划， 最终目标是促进临床护理，减少成年后的经济和社会影响。

PROJECT SUMMARY The incidence of chronic pain rises dramatically during adolescence and results in changes that disrupt normative developmental trajectories, as reflected in missed schooling, withdrawal from social activities, family dysfunction, and overdependence on parents. While there is strong empirical support for the initial and short- term impact of adolescent chronic pain, little is known regarding the life course consequences. Determining the long-term impact of adolescent pain is critical for informing targets of preventative interventions, lessening suffering, and promoting positive adjustment in adulthood. The specific aims of this project are to (1) determine the long-term impact of adolescent chronic pain on developmental and health outcomes in young adulthood (Study 1) and (2) identify intraindividual (e.g., anxiety) and interindividual (e.g., family functioning) vulnerabilities in adolescence that amplify risk for adverse outcomes (Study 2). We will take an integrative approach to examine key transitional outcomes of young adulthood: (1) educational achievement, (2) vocational achievement, (3) peer and romantic relationships, (4) independent living, (5) general health status, (6) chronic pain symptoms, and (7) transition to adult medical care. The project aims will be accomplished through completion of two complementary studies during the applicant's two-year fellowship period. Study 1 is a secondary data analysis of the National Longitudinal Survey of Adolescent to Adult Health to examine adolescent chronic pain (Wave I and Wave II) as a risk factor for adverse young adult outcomes (Wave III). Study 2 involves a new follow-up data collection of 140 young adults (ages 18-25) who, during adolescence (ages 11-17), participated in a prior NIH-funded randomized controlled trial of an internet-delivered pain management program. We will leverage data from the prior trial's baseline assessment of pain and intrapersonal and interpersonal vulnerabilities to predict current health and development in young adulthood. In combination, these studies represent a unique opportunity to determine the extent to which adolescents with chronic pain are at risk for long-term adversities, and identify early vulnerability factors that may influence poor outcomes. The planned research and corresponding training activities under this two-year postdoctoral fellowship award will allow the applicant to build expertise in developmentally-grounded pediatric pain research and advanced longitudinal cohort design and analysis. Training will also focus on grant writing and scholarly productivity in the field of pain. Attainment of this Ruth L. Kirschstein National Research Service Award will support the applicant in developing the scientific and leadership skills necessary to build an independent research career and a promising new program of science on the life course consequences of pediatric pain, with the ultimate goal of advancing clinical care and lessening the economic and social impact in adulthood.