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

项目摘要（来自母公司的奖励） 这个K23职业发展奖的长期目标是准备PI（Rachel Aaron，博士） 一个独立的研究事业，旨在促进适应性恢复的个人谁生存骨科 外伤骨科创伤，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性疼痛， 在受伤后的一年中出现心理困扰，大多数人在创伤后7年报告严重残疾。 有迫切需要确定的因素，潜在的疼痛和心理困扰后，矫形 创伤，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，情绪调节的困难（即，识别自己的情绪 并参与上调或下调它们的策略）和中枢致敏（即，的改变 疼痛的内源性调节）导致不良的疼痛相关结果。使用理论驱动的评估 情绪调节和金标准，基于实验室的评估中枢敏感（定量 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感化 作为创伤后6个月持续疼痛、痛苦和阿片类药物使用的预测因素。研究2将测试 评估和提供情绪意识和表达疗法（EAET）的可行性 支持持续疼痛的人（即，临床上显著的疼痛，在过去3个月的大多数日子里都存在） 创伤后数月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： 针对创伤相关的情绪调节过程。创伤暴露在骨科创伤中普遍存在 幸存者;因此，EAET可能非常适合那些创伤后持续疼痛的人。然而，可行性 提供EAET是不清楚的，由于建立的障碍，使这一人群在心理健康治疗。 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)著名的研究环境。JHU致力于其初级教师的成功，并提供 骨科创伤患者的独特通道。独立监察员在中环成立了一支强大的内容专家团队， 致敏（包括QST）、心理干预（包括EAET）和骨科创伤。沉浸 在JHU丰富的培训环境中，PI将通过专门的指导实现以下职业目标， 教学经验和专业发展机会：（1）发展评估专业知识， 中央宣传，包括QST;（2）获得干预措施制定，实施， 和分析;（3）学会领导有影响力的骨科创伤临床研究。完成K23 该提案将为PI提供必要的培训和初步数据，以获得独立的赠款资金 并系统地进行一系列研究，以改善骨科创伤幸存者的预后。

PROJECT SUMMARY (from parent award) 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.