Pain in community-based older African American Adults: The Jackson Heart Study

慢性疼痛影响超过1亿美国成年人，估计每年花费560 - 6350亿美元， 这一主要负担在非裔美国人（AAs）中研究相对不足。老年人的风险增加 患有多种疼痛疾病，并且在慢性疼痛的负面影响下寿命更长。慢性疼痛， 不管涉及的解剖结构或诊断（例如，背痛，偏头痛），是残疾的主要原因 国际吧有限的见解是否共同机制的基础上所有的疼痛条件，无论 诊断，导致疼痛管理选择不足。治疗一种疼痛的医疗保健提供者 条件（例如，关节痛）通常不能控制身体其它部位的症状（例如，腹痛）， 病人经常从一个专家转到另一个专家。研究各种慢性 在基于社区的队列中，重叠疼痛状况（COPC）可以提供 对慢性疼痛作为一种疾病本身的原因和后果的新见解。例如，神经生理学 疼痛处理的改变，如疼痛敏感化（评估上行疼痛通路）和条件反射 疼痛调制（CPM）（评估下行疼痛调制）可能是所有疼痛的共同机制。 慢性疼痛这些知识将刺激开发新的疼痛管理方法，用于所有类型的疼痛。 疼痛，无论涉及解剖结构或诊断。尽管慢性疼痛给公共卫生带来了巨大的负担， 关于COPC在老年AA成人中的流行病学和演变，以及COPC对AA的影响， 身体或心理社会功能，入住疗养院的风险，以及老年AA的死亡率。我们建议 在即将到来的研究访问中评估慢性疼痛，该研究访问以社区为基础的老年AA队列 杰克逊心脏研究（JHS）（N~2540，三分之二≥ 65岁）中的任何疼痛投诉。我们的目标是 了解COPC的流行病学，无论涉及解剖或诊断，COPC的演变 随着时间的推移，疼痛处理的神经生理学改变，健康的生活方式因素和心理社会因素， COPC的危险因素，以及COPC的后果和老年人疼痛处理的改变。我们提出 获得疼痛敏感和CPM的客观定量感觉测试（QST）指标， 与疼痛严重程度相关。QST评估的神经生理学改变是否可能 是所有形式慢性疼痛的常见潜在风险因素，也是身体和心理社会不良的常见潜在风险因素。 功能，制度化，和死亡率在一个以社区为基础的队列的老年AAs的疼痛是 未知我们将收集关于多种慢性疼痛状况、QST、健康生活方式因素的数据， 身体和心理社会功能，以及下一次计划研究访视期间入住疗养院，以及 两次随访评估，以获得纵向数据，并利用正在进行的JHS死亡率监测。 我们的工作将解决几个知识差距，获得的见解可能最终促进新的预防和 治疗方法，以缓解慢性疼痛及其后果，无论潜在的诊断。

Chronic pain affects over 100 million American adults, with an estimated cost of $560-635 billion annually, yet this major burden is relatively understudied in African Americans (AAs). Older adults are at increased risk of having multiple painful conditions and are living longer with the negative impacts of chronic pain. Chronic pain, regardless of anatomy or diagnosis involved (e.g., back pain, migraine), is the leading cause of disability worldwide. Limited insights into whether common mechanisms underlie all pain conditions, regardless of diagnosis, has contributed to inadequate pain management options. Health care providers who treat one pain condition (e.g., joint pain) typically do not manage symptoms in other parts of the body (e.g., abdominal pain), and patients are often referred from one specialist to another. Studying commonalities of various chronic overlapping pain conditions (COPC) in community-based cohorts unselected for pain conditions can provide novel insights into causes and consequences of chronic pain as a disease itself. For example, neurophysiologic alterations in pain processing such as pain sensitization (assessing ascending pain pathways) and conditioned pain modulation (CPM) (assessing descending pain modulation) may be common mechanisms underlying all chronic pain. Such knowledge would spur development of novel pain management approaches for all types of pain regardless of anatomy or diagnosis involved. Despite the substantial public health burden of chronic pain, little is known about the epidemiology and evolution of COPC in older AA adults, nor of the impact of COPC on physical or psychosocial function, risk of nursing home admission, and mortality in older AAs. We propose to evaluate chronic pain in the upcoming study visit of a thoroughly-characterized community-based older AA cohort unselected for any pain complaints, the Jackson Heart Study (JHS) (N~2540, two-thirds ≥age 65). We aim to understand the epidemiology of COPC, regardless of anatomy or diagnosis involved, the evolution of COPC over time, neurophysiologic alterations in pain processing, healthy lifestyle factors and psychosocial factors as risk factors for COPC, and consequences of COPC and altered pain processing in older adults. We propose acquiring objective quantitative sensory testing (QST) measures of pain sensitization and CPM, which are associated with pain severity in experimental settings. Whether QST-assessed neurophysiologic alterations may be common underlying risk factors for all forms of chronic pain, and for poor physical and psychosocial functioning, institutionalization, and mortality in a community-based cohort of older AAs unselected for pain is unknown. We will collect data regarding a multitude of chronic pain conditions, QST, healthy lifestyle factors, physical and psychosocial function, and nursing home admissions during the next planned study visit, as well as two follow-up assessments to obtain longitudinal data, and leverage the ongoing JHS surveillance of mortality. Our work will address several knowledge gaps, and insights gained may ultimately facilitate new preventive and therapeutic approaches to relieving chronic pain and its consequences, regardless of underlying diagnosis.