Optimizing pain-related outcomes following orthopedic trauma: testing novel risk factors and determining the feasibility of a new pain psychology intervention

项目总结 这个K23职业发展奖的长期目标是准备PI(Rachel Aaron，PhD) 一项独立的研究事业，旨在促进整形外科幸存者的适应性恢复 精神创伤。骨科创伤，导致严重损伤，如多处骨折或截肢，发生在 美国每年约有300万人；约一半的幸存者经历持续的疼痛和 受伤后一年的心理痛苦，大多数人报告说在创伤后7年有严重残疾。 迫切需要确定骨科手术后疼痛和心理困扰的潜在因素。 并制定有针对性的心理干预措施，以治疗这些潜在的致残症状。 更广泛的文献表明，情绪调节(即识别一个人的情绪)的困难 以及参与对它们进行上调或下调的策略)和中枢敏化(即， 疼痛的内源性调节)会导致与疼痛相关的不良结果。使用理论驱动的评估 情绪调节和以实验室为基础的中枢敏化的黄金标准评估(量化 感觉测试[QST])，研究1将在6周时检查情绪调节困难和中枢敏化 创伤后作为持续性疼痛、痛苦和阿片类药物使用的预测因子。研究2将测试 评估和传递情绪意识与表达疗法(EAET)的可行性 世卫组织在6岁时认可持续性疼痛(即临床上显著的疼痛，过去3个月中出现的时间最多) 创伤后几个月。EAET是一种新型的慢性疼痛心理干预，通过以下方式治疗疼痛和痛苦 以创伤相关情绪调节过程为靶点。创伤暴露在骨科创伤中普遍存在 因此，EAET可能非常适合创伤后持续疼痛的患者。然而，其可行性 由于既定的障碍使这些人口接受心理健康治疗，提供EAET的可能性尚不清楚。 拟议的研究和职业发展活动将在约翰·霍普金斯大学进行 (JHU)，一个著名的研究环境。JHU致力于其初级教员的成功，并为 独一无二的获得骨科创伤患者的机会。PI在中环组建了一支强大的内容专家团队 敏感化(包括QST)、心理干预(包括EAET)和骨科创伤。沉浸其中 在JHU丰富的培训环境中，PI将通过专注的指导实现以下职业目标， 教学经验和职业发展机会：(1)在评估中培养专业知识 中心敏感化，包括QST；(2)获得制定、实施、 和分析；(3)学会领导有影响力的骨科创伤临床研究。这座K23的完工 提案将为PI提供必要的培训和初步数据，以获得独立的赠款资金 并系统地开展一系列研究，以改善骨科创伤幸存者的预后。

PROJECT SUMMARY The long-term goal of this K23 Career Development Award is to prepare the PI (Rachel Aaron, PhD) for an independent research career that aims to promote adaptive recovery for individuals who survive orthopedic trauma. Orthopedic trauma, resulting in severe injuries such as multiple fractures or amputation, occurs in around 3 million people annually in the United States; about half of survivors experience persistent pain and psychological distress in the year following injury, and most report substantial disability 7 years post trauma. There is an urgent need to identify factors that underlie pain and psychological distress following orthopedic trauma and to develop targeted psychological interventions to treat these potentially disabling symptoms. The broader literature suggests that difficulties with emotion regulation (i.e., identifying one's emotions and engaging in strategies to up- or down-regulate them) and central sensitization (i.e., alterations in the endogenous modulation of pain) lead to poor pain-related outcomes. Using a theory-driven assessment of emotion regulation, and gold-standard, laboratory-based assessment of central sensitization (quantitative sensory testing [QST]), Study 1 will examine emotion regulation difficulties and central sensitization at 6 weeks post trauma as predictors of persistent pain, distress, and opioid use 6 months post trauma. Study 2 will test the feasibility of assessing and delivering Emotional Awareness and Expression Therapy (EAET) to people who endorse persistent pain (i.e., clinically significant pain, present most days for the past 3 months) at 6 months post trauma. EAET is a novel chronic pain psychology intervention that treats pain and distress by targeting trauma-related emotion regulation process. Trauma exposure is ubiquitous among orthopedic trauma survivors; thus, EAET may be ideally suited for those with persistent pain post trauma. However, the feasibility of delivering EAET is unclear due to established barriers engaging this population in mental health treatment. Proposed research and career development activities will take place at Johns Hopkins University (JHU), a renowned research environment. JHU is dedicated to the success of its junior faculty and provides unique access to orthopedic trauma patients. The PI has formed a strong team of content experts in central sensitization (including QST), psychological intervention (including EAET), and orthopedic trauma. Immersed in JHU's rich training environment, the PI will achieve the following career goals through dedicated mentorship, didactic experiences, and professional development opportunities: (1) develop expertise in the assessment of central sensitization, including QST; (2) gain foundational skills for intervention development, implementation, and analysis; and (3) learn to lead impactful orthopedic trauma clinical research. The completion of this K23 proposal will provide the necessary training and preliminary data for the PI to obtain independent grant funding and systematically pursue a line of research to improve outcomes for survivors of orthopedic trauma.