Determining Mechanisms of Pain Reduction in Chronic Widespread Pain After Rapid Weight Loss in Non-Hispanic Black and Hispanic/Latino/a/x Adults

项目摘要/摘要 慢性广泛性疼痛(CWP)是一种慢性疼痛亚型，影响身体多个部位，且 与功能不佳和残疾有关。尽管CWP在肥胖成年人中非常普遍，但CWP 非西班牙裔黑人(NH Black)和西班牙裔/拉丁裔/a/x成年人的结果不成比例地更差。因此， CWP中与肥胖相关的健康差异可能会扩大这些地区现有的种族和民族痛苦差异 人口。减肥手术通常是用来治疗肥胖和肌肉骨骼疼痛并存的。 然而，减肥手术后的体重减轻和疼痛轨迹有显著的差异。此外，许多人 患者在减肥手术后会经历反复或未缓解的疼痛，这些疼痛可以抑制体重减轻或促进 体重又恢复了。我们对水煤浆结果的主要驱动力(S)以及如何 CWP的司机(S)对减肥做出了回应，特别是在种族和民族多元化的群体中。因此，主要的 以患者为中心的研究生涯发展导师计划的目标 奖项(K23)旨在通过以下方式填补这些知识空白：1)全面描述休息和运动时的疼痛-- NH Black和西班牙裔/拉丁裔/a/x成年人减肥手术后的诱发疼痛(MEP)，以及2)识别潜在的 减肥手术后缓解或维持疼痛的组内差异的关键驱动因素(S)。我们会 重点关注疼痛敏感性、关节运动和机械负荷生物特征，以及心理社会因素。目标 在此K23应用程序中提出的高度创新的方法可协同基于机制的疼痛 表型与肥胖和健康差异的研究方法。所采用的方法代表了 从静态、自我报告的疼痛评估转向整合严格的评估和 用伤害性加工的精确量化测量静息疼痛和MEP的多个维度 以及联合运动和在不同种族的人群中加载生物签名。对于K23，我已经组装了一个 由非常成功的临床、基础和翻译科学家组成的跨学科和跨文化的强大干部队伍 对成功实施和完成我的职业生涯有强烈和可证明的承诺 发展计划和研究项目里程碑。主要的培训目标是我的关键 研究、培训和职业发展是：1)发展减肥和减肥相结合的专门知识 使用疼痛表型数据评估生活方式改变，2)开发和实施临床试验设计， 识别和解决疼痛差异，以及3)加强高级统计方法方面的培训，以向临床提供信息 用于检查疼痛差异的试验设计。纽约大学和佛罗里达大学非常强大 疼痛、肥胖和康复研究的孵化器。此外，这些机构是强有力的研究机构 有资源可供我在之前的培训基础上培养独立性的环境 这项研究的重点是改善不同种族和民族的肥胖成年人的疼痛管理。

Project Summary/Abstract Chronic widespread pain (CWP) is a chronic pain subtype that affects multiple body sites, and is strongly associated with poor function and disability. Although CWP is highly prevalent in adults with obesity, CWP outcomes are disproportionately worse in non-Hispanic Black (NH Black) and Hispanic/Latino/a/x adults. Thus, the obesity-related health disparity in CWP could augment existing racial and ethnic pain disparities in these populations. Bariatric surgery is often prescribed to treat obesity and musculoskeletal pain comorbidities. However, there is significant variability in weight loss and pain trajectories after bariatric surgery. Moreover, many patients experience recurrent or unresolved pain after bariatric surgery that can inhibit weight loss or facilitate weight regain. There are critical gaps in our knowledge of the primary driver(s) of CWP outcomes and how driver(s) of CWP respond to weight loss, particularly in racial and ethnically diverse groups. As such, the main objective of the proposed mentored project for the Mentored Patient-Oriented Research Career Development Award (K23) is to fill these knowledge gaps by: 1) comprehensively characterizing pain at rest and movement- evoked pain (MEP) in NH Black and Hispanic/Latino/a/x adults after bariatric surgery, and 2) identifying potential key driver(s) of intra-group variability in the resolution or maintenance of pain after bariatric surgery. We will focus on pain sensitivity, joint motion and mechanical loading biosignatures, and psychosocial factors. The aims proposed in this K23 application feature highly innovative methods that synergize mechanism-based pain phenotyping with obesity and health disparities research approaches. The methodologies employed represent a substantive departure from static, self-reported pain assessment to the integration of rigorous assessment and measurement multiple dimensions of pain at rest and MEP using precise quantification of nociceptive processing and joint motion and loading biosignatures in ethnically diverse populations. For the K23, I have assembled a strong interdisciplinary and multicultural cadre of highly successful clinical, basic, and translational scientists who have a strong and demonstrable commitment to the successful implementation and completion of my career development plan and research project milestones. The primary training goals that are the linchpin of my research training and career development are: 1) developing expertise in the integration of weight loss and lifestyle change evaluations with pain phenotyping data, 2) to develop and implement clinical trial designs that identify and address pain disparities, and 3) to enhance training in advanced statistical methods to inform clinical trial design to examine pain disparities. New York University (NYU) and the University of Florida are very strong incubators of pain, obesity, and rehabilitation research. Furthermore, these institutions are robust research environments that have the resources available to me to build on my previous training to foster independence in research that is focused on improving pain management in racially and ethnically diverse adults with obesity.