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

慢性疼痛影响着超过1亿的美国成年人，估计每年要花费5600亿到6350亿美元 在非裔美国人(AA)中，这一主要负担相对较少被研究。老年人罹患癌症的风险增加 有多种痛苦状况，并因慢性疼痛的负面影响而活得更长。慢性疼痛, 无论涉及的解剖或诊断(例如，背部疼痛、偏头痛)是导致残疾的主要原因 全世界。对于共同机制是否是所有疼痛状况的基础，洞察有限，无论 诊断结果不佳，导致疼痛管理选择不足。治疗一种疼痛的医疗保健提供者 病情(例如关节疼痛)通常不能控制身体其他部位的症状(例如腹痛)， 病人经常被从一个专科医生转诊到另一个专家。研究各种慢性病的共性 未被选为疼痛条件的社区队列中的重叠疼痛条件(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 疼痛处理的变化，如疼痛敏感化(评估上行疼痛通路)和条件化 疼痛调制(CPM)(评估下行疼痛调制)可能是ALL的共同机制 慢性疼痛。这些知识将刺激所有类型的疼痛管理方法的发展 疼痛，与解剖或诊断无关。尽管慢性疼痛给公共卫生带来了沉重的负担， 对于老年再生障碍性贫血患者的COPC的流行病学和演变，以及COPC对 老年再障患者的身体或心理社会功能、入住疗养院的风险和死亡率。我们建议 评估即将到来的以社区为基础的老年AA队列研究访问中的慢性疼痛 没有选择任何疼痛主诉，杰克逊心脏研究(JHS)(N~2540，三分之二≥年龄65岁)。我们的目标是 了解COPC的流行病学，无论涉及的解剖或诊断，COPC的演变 随着时间的推移，疼痛处理中的神经生理学变化，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和老年人疼痛处理改变的后果。我们建议 获得疼痛敏感化和CPM的客观定量感觉测试(QST)测量，这些测量是 在实验环境中与疼痛严重程度相关。QST评估的神经生理学改变是否可以 是所有形式的慢性疼痛以及不良的生理和心理社会的共同潜在风险因素 未选择用于疼痛的社区老年AA队列中的功能、制度化和死亡率 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，以及在下一次计划的学习访问期间入住疗养院，以及 两次后续评估，以获得纵向数据，并利用JHS正在进行的死亡率监测。 我们的工作将解决几个知识差距，所获得的见解最终可能有助于新的预防和 缓解慢性疼痛及其后果的治疗方法，而不考虑潜在的诊断。

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.