Clinical Implications of Pain Phenotypes in Sickle Cell Disease

描述（由申请人提供）： 在这个建议中，我们的生物行为疼痛研究人员团队与约翰霍普金斯医院成人SCD研究人员团队一起，解决SCD疼痛管理的令人难以置信的挑战。尽管SCD患者的临床结局存在巨大的个体差异，并且几乎每天都有明显的疼痛经历，但目前对SCD的疼痛表型以及这些表型如何预测临床结局知之甚少。我们的团队试图证明，疼痛表型的个体差异发生在SCD中，疼痛的炎症/免疫反应有助于这些表型，这些疼痛表型预测SCD的重要临床结局。我们提出了两个连续的研究：研究1将使用情绪，个性和疼痛相关的灾难化和基于实验室的疼痛处理，包括疼痛敏感性和疼痛诱发的炎症/免疫反应的措施，疼痛表型的特征。为了确定这些疼痛表型是否是SCD特有的，将在非裔美国成年SCD患者和一组匹配的健康非裔美国成年人之间比较实验室疼痛处理措施。为了确定实验室中引发的炎症/免疫应答的临床效用和预测有效性，将在SCD患者中检查需要住院治疗的血管闭塞危象（VOC）期间的炎症和免疫应答水平。研究2将确定疼痛表型是否前瞻性预测SCD的临床结局。临床结果的测量将包括平均每日疼痛，VOC的频率和严重程度，以及用于疼痛管理的医疗保健的计划外使用。将检查研究2中因VOC管理而入住约翰霍普金斯医院镰状细胞输注中心的受试者的病历数据，以确定阿片类药物反应性。识别标准化措施的能力，如疼痛敏感性，疼痛诱发的炎症/免疫反应和心理社会因素，有助于解释患者的临床过程，特别是他们对阿片类药物治疗的反应，将对医疗保健提供者如何处理这些患者的疼痛管理产生巨大影响。不同的镰状细胞病（SCD）患者有非常不同的疼痛体验，对止痛药的反应也不同。我们的项目将使用实验室方法来研究疼痛敏感性的差异，并确定这些差异是否预测临床结果，包括SCD疼痛的日常经历，血管闭塞危象的频率和严重程度，以及非计划性使用医疗保健进行疼痛管理。(End摘要）

DESCRIPTION (provided by applicant): In this proposal, our team of biobehavioral pain researchers joins with the Johns Hopkins Hospital team of adult SCD researchers to address the incredible challenge of pain management in SCD. Despite tremendous individual differences in clinical outcomes among patients with SCD and the clear widespread experience of almost daily pain, very little is currently known about pain phenotypes in SCD and how these phenotypes predict clinical outcomes. Our team seeks to demonstrate that individual differences in pain phenotypes occur in SCD, that inflammatory/immune responses to pain contribute to these phenotypes, and that these pain phenotypes predict important clinical outcomes in SCD. We propose two sequential studies: Study 1 will characterize pain phenotypes using measures of mood, personality, and pain-related catastrophizing and measures of laboratory-based pain processing, including pain sensitivity and pain-evoked inflammatory/immune responses. In order to determine whether these pain phenotypes are specific to SCD, laboratory pain processing measures will be compared between African American adult SCD patients and a group of matched, healthy African American adults. In order to determine the clinical utility and predictive validity of the inflammatory/immune response elicited in the laboratory, level of inflammation and immune response during a vaso-occlusive crisis (VOC) requiring hospital care will be examined in the SCD patients. Study 2 will determine whether pain phenotypes prospectively predict clinical outcomes in SCD. Measures of clinical outcome will include average daily pain, frequency and severity of VOC, and unscheduled use of health care for pain management. Medical record data for participants in Study 2 who are admitted to the Johns Hopkins Hospital Sickle Cell Infusion Center for the management of VOC will be examined to determine opioid responsivity. The ability to identify standardized measures, such as pain sensitivity, pain-evoked inflammatory/immune responses, and psychosocial factors, that help explain patients' clinical course, and especially their responses to opioid therapy, will have a dramatic effect on how health care providers approach pain management in these patients. Different people with sickle cell disease (SCD) have very different experiences of pain and respond differently to pain medications. Our project will use laboratory methods to study differences in pain sensitivity and determine whether these differences predict clinical outcomes, including the daily experience of SCD pain, the frequency and severity of vaso-occlusive crisis, and unscheduled use of health care for pain management. (End of Abstract)