Mechanisms of transition from acute to chronic pain in Non-Hispanic Black and White injury patients

目前对种族如何以及为什么影响从急性到慢性疼痛的转变的理解， 创伤仍然有限。创伤性损伤导致超过3000万次急诊就诊， 在美国，每年有100万人住院治疗。 非西班牙裔黑人（NHB）患者与非西班牙裔白色（NHW）患者的相似损伤进行比较。 虽然NHB患者经历更高水平的急性伤后疼痛，更有可能过渡到 慢性疼痛的患者比NHW患者，影响这种转变的生物行为和社会因素并不好 明白本提案的总体目标是增进对影响全球化的因素的了解， 过渡到损伤后慢性疼痛和形成种族疼痛差异。为了实现我们的目标，我们将招募150名 来自1级创伤中心的NHB和150名NHW成人创伤骨科损伤，并评估疼痛 住院期间和每月随访期间的结局。首先，我们将识别相似性和差异性 生物行为因素在多大程度上解释了NHB和NHW患者的损伤后慢性疼痛。我们 假设更大的疼痛敏感性（在医院通过定量感觉测试进行评估）， 炎症生物标志物（hsCRP、TNFα、IL 1 β、IL-6）、更多的负面认知（灾难化、疼痛/治疗 期望），并且更高的抑郁/创伤后应激症状将预测损伤后慢性疼痛（即， 慢性疼痛发作的几率更高，疼痛强度和干扰更大）。如果 慢性疼痛风险受种族的调节，我们假设NHB中损伤后慢性疼痛相对于 NHW患者的部分原因是较高的生物行为风险因素。第二，我们将确定相似之处 以及社会因素解释NHB和NHW患者损伤后慢性疼痛的程度的差异。 我们假设社会风险因素（更大的生活和邻里压力，更低的社会经济地位）将 预测NHB和NHW患者的损伤后慢性疼痛，社会保护因素（较高的社会 支持）将缓冲社会风险因素的影响。如果慢性疼痛风险受种族影响， 假设NHB相对于NHW患者损伤后慢性疼痛更严重，部分原因是 社会风险因素较高。综合评估多种风险和保护因素， 生物心理社会模型的水平将促进对损伤后通路的理解， NHB和NHW成人的慢性疼痛，包括与过渡到 慢性疼痛评估院内诱发疼痛敏感性作为损伤后慢性疼痛发展的预测因子 代表了一项重大创新。这些知识可以刺激开发具有成本效益的可扩展屏幕 在医院环境中解决疼痛的种族差异。研究人员聚集在一起， 团队在创伤性损伤、慢性疼痛、定量感觉测试 炎症，疼痛相关的生物行为和社会因素，以及慢性疼痛的种族差异。

Current understanding of how and why race influences the transition from acute to chronic pain following traumatic injury remains limited. Traumatic injuries result in over 30 million emergency department visits and 2.5 million hospitalizations each year in the U.S. Risk for developing post-injury chronic pain is significantly greater for non-Hispanic Black (NHB) patients compared to non-Hispanic White (NHW) patients with similar injuries. Although NHB patients experience higher levels of acute post-injury pain and are more likely to transition to chronic pain than NHW patients, the biobehavioral and social factors that influence this transition are not well understood. The overall aim of this proposal is to improve understanding of the factors that influence the transition to post-injury chronic pain and shape racial pain disparities. To address our aims, we will recruit 150 NHB and 150 NHW adults with traumatic orthopedic injuries from a level 1 trauma center and assess pain outcomes during hospitalization and across monthly follow-ups. First, we will identity similarities and differences in the extent to which biobehavioral factors explain post-injury chronic pain in NHB and NHW patients. We hypothesize that greater pain sensitivity (assessed in hospital via quantitative sensory testing), elevated acute inflammatory biomarkers (hsCRP, TNFα, IL1β, IL-6), more negative cognitions (catastrophizing, pain/treatment expectations), and higher depressive/posttraumatic stress symptoms will predict post-injury chronic pain (i.e., higher odds of chronic pain onset, greater pain intensity and interference) in both NHB and NHW patients. If chronic pain risks are moderated by race, we hypothesize that worse post-injury chronic pain in NHB relative to NHW patients will be explained, in part, by higher biobehavioral risk factors. Second, we will identify similarities and differences in the extent to which social factors explain post-injury chronic pain in NHB and NHW patients. We hypothesize that social risk factors (greater life and neighborhood stress, lower socioeconomic status) will predict post-injury chronic pain in both NHB and NHW patients, and that social protective factors (higher social support) will buffer against in the influence of social risk factors. If chronic pain risks are moderated by race, we hypothesize that worse post-injury chronic pain in NHB relative to NHW patients will be explained, in part, by higher levels of social risk factors. The comprehensive assessment of risk and protective factors across multiple levels of the biopsychosocial model will advance understanding of the pathways that contribute to post-injury chronic pain for both NHB and NHW adults, including factors implicated in racial differences in transition to chronic pain. Evaluating in-hospital evoked pain sensitivity as a predictor of post-injury chronic pain development represents a major innovation. This knowledge could spur the development of cost-effective, scalable screens for hospital settings to redress racial disparities in pain. The investigators assembled for this multidisciplinary team possess complementary skill sets in traumatic injury, chronic pain, quantitative sensory testing, inflammation, pain-relevant biobehavioral and social factors, and racial disparities in chronic pain.