Resilience Factors, Pain, and Physical Activity in Adolescent Chronic Musculoskeletal Pain

项目总结和摘要： 慢性肌肉骨骼疼痛（CMSKP）在青少年中很常见。定期参加体育活动（PA） 有效降低CMSKP，但PA参与率仍低于建议水平。需要更好地 了解在青少年CMSKP中更好地促进PA的方法（例如，减少久坐活动vs.增加 中度至剧烈PA），影响PA的因素（例如，弹性，疼痛调节，压力失调），以及 这些因素如何影响PA和疼痛的机制基础。这些知识可能会导致 改善CMSKP的干预措施。建立在积极属性基础上的心理弹性因素，例如 自我效能、动机和心理灵活性可能有助于青少年参与PA。虽然韧性 这些因素对整体疼痛应对很重要，但直到最近才被认为是PA的预测因素。的 本提案的总体目标是制定和试行一项提高复原力的干预措施的可行性研究 对于患有CMSKP的青少年的PA。这一点很重要，因为这种干预措施的发展可能 导致PA改善，随后改善CMSKP青少年的慢性疼痛。本研究首先 评估弹性因素对青少年CMSKP患者PA和疼痛的作用途径（目的1），以及 痛苦和压力60名CMSKP青少年将完成自我报告的韧性和脆弱性措施 因素，并客观测量PA，疼痛（定量感觉测试）和压力（皮质醇觉醒 响应）。我们将评估内源性疼痛调节和应激调节是否介导了 弹性与PA之间的关系本研究还将考虑在以下方面具有重要意义的弹性因素： 预测久坐不动的PA作为干预目标，并将制定，完善（目标2）和（目标3）进行 一项针对青少年慢性疼痛干预的可行性和可接受性试点研究（疼痛缓解 促进青年[PREP-Y]）。该手册将根据既定的治疗方案制定， 青少年中的青少年CMSKP（即，FIT青少年），并修改为目标弹性机制和久坐 活动这将通过儿科疼痛和CMSKP患者的内容专家的综合反馈来完成。 然后将向30名患者提供干预，每组4至6人。该项目将作为 一个强大的职业发展计划，包括课程，体验式培训，并从密集的导师 儿科行为干预开发和评估专家团队， 儿科疼痛、身体活动干预和疼痛生理学及评估。完成本研究将 发生在两个学术医疗中心与儿科联合部门，一个完善的疼痛治疗 服务，研究机构，以促进研究教师的成长和发展。这次学习 职业发展计划将促进建立独立的，校外资助的临床研究 该计划旨在改善青少年CMSKP的临床有意义的结果。

PROJECT SUMMARY AND ABSTRACT: Chronic musculoskeletal pain (CMSKP) is common in adolescents. Participation in regular physical activity (PA) is effective in reducing CMSKP but PA participation is still below recommended levels. There is a need to better understand ways to better promote PA in adolescent CMSKP (e.g., decreasing sedentary activity vs. increasing moderate to vigorous PA), factors that affect PA (e.g., resilience, pain modulation, stress dysregulation), and the mechanistic underpinnings of how these factors affect PA and pain. This knowledge may lead to the development of improved interventions for CMSKP. Psychological resilience factors that build on positive attributes, such as self-efficacy, motivation, and psychological flexibility may help adolescents to engage in PA. While resilience factors are important for overall pain coping, they only recently are being considered as predictors for PA. The overall goal of this proposal is to develop and pilot a feasibility study of an intervention that increases resilience for PA in adolescents with CMSKP. This is significant because the development of such an intervention may lead to improved PA and subsequently improved chronic pain for adolescents with CMSKP. This study first evaluates pathways of resilience factors on PA and pain in adolescents with CMSKP (Aim 1), and the modulation of pain and stress. 60 adolescents with CMSKP will complete self-report measures of resilience and vulnerability factors, and objectively measured PA, pain (Quantitative Sensory Testing), and stress (Cortisol Awaking Response). We will evaluate whether endogenous pain modulation and stress regulation mediate the relationships between resilience and PA. This study also will consider resilience factors that are significant in predicting less sedentary PA as intervention targets, and it will develop, refine (Aim 2) and (Aim 3) conduct a pilot feasibility and acceptability study of a resilience-focused chronic pain intervention for youth (Pain REsilience Promotion for Youth [PREP-Y]). The manual will be developed based on an established treatment program for adolescent CMSKP in adolescents (i.e., FIT Teens) and modified to target resilience mechanisms and sedentary activity. This will be done with integrated feedback from content experts in pediatric pain and CMSKP patients. The intervention will then be provided to 30 patients in groups of 4 to 6. This project will be implemented as part of a strong career development plan consisting coursework, experiential training, and intensive mentorship from a team of experts in pediatric behavioral intervention development and evaluation, psychological factors of pediatric pain, physical activity intervention, and pain physiology and assessment. Completion of this study will occur across two academic medical centers with a joint department of pediatrics, a well-establish pain treatment service, and research institutes to promote the growth and development of research faculty. This study and career development plan will promote the establishment of independent, extramurally funded clinical-research program focused on improving clinically meaningful outcomes for adolescents CMSKP.