Efficacy of Acute Pain Management on Chronic Pain Following Lower Extremity Trauma

描述（由申请人提供）：申请人要求获得美国国家护理研究中心Ruth L. Kirschstein国家研究服务奖（F31）的支持，以研究创伤后慢性疼痛。慢性疼痛是一个重要的公共健康问题，影响了三分之一的美国成年人，给他们带来了相当大的经济和个人负担。创伤是慢性疼痛的主要来源；创伤患者报告身体残疾、创伤后应激障碍、缺勤天数、医疗保健就诊增加、焦虑和抑郁的发生率很高。创伤时的高疼痛强度已被确定为慢性疼痛的危险因素，但导致慢性疼痛的最小疼痛强度或未缓解疼痛的严重程度的精确水平尚不清楚。此外，创伤患者在损伤恢复后疼痛超敏反应的发生率并没有很好的记录。本研究的目的是测试未缓解的创伤后疼痛是否与下肢创伤后慢性疼痛和疼痛超敏反应有关。拟议的研究将：(1)确定和描述创伤性损伤时的疼痛阈值、持续时间和时间效应如何与下肢创伤后的慢性疼痛相关；(2)测试中枢致敏的神经元变化是否存在于该人群中。目的1将通过对成人创伤患者的医疗记录进行回顾性审查，以检查创伤后住院期间疼痛等级的模式、强度和镇痛药的使用，来研究下肢创伤后未缓解的急性疼痛与慢性疼痛的相关性。对于Aim 2， Aim 1的一部分参与者将根据入院前24小时的平均疼痛评分分为四组之一：(1)平均疼痛评分<2，无慢性疼痛；(2)平均疼痛评分>2，无慢性疼痛；(3)平均疼痛评分<2，慢性疼痛；(4)平均疼痛评分>2，慢性疼痛。一组年龄/性别匹配的创伤幼稚参与者将作为规范对照。完成对中枢致敏引起的中枢神经元可塑性变化的评估：定量感觉测试测量疼痛超敏性，当前感知阈值测试测量感觉纤维功能，条件疼痛调节评估弥漫性有害抑制控制，压力疼痛阈值评估机械疼痛敏感性。本建议中概述的培训将加强申请人之前的培训，使其成为一名独立的护士科学家，其研究项目侧重于与慢性疼痛相关的潜在生物学机制。慢性疼痛研究与NINR的使命非常一致，即确定影响患者生活质量的症状（例如疼痛）的潜在生物学基础。培训将侧重于：(1)增加申请人对慢性疼痛病理生理学的知识基础；(2)丰富她与临床研究相关的方法和分析技能，(3)成功的论文答辩和提高拨款和手稿写作技能。研究结果可能有助于开发新的治疗策略，以减少慢性疼痛。

DESCRIPTION (provided by applicant): The applicant requests support from a NINR Ruth L. Kirschstein National Research Service Awards for Individual Predoctoral Fellows in Nursing Research (F31) to examine chronic pain following trauma. Chronic pain is a significant public health problem affecting one third of the U.S. adult population with a considerable economic and personal burden. Trauma is a major source of chronic pain; trauma patients report high rates of physical disability, post-traumatic stress disorder, missed days of work, increased healthcare encounters, anxiety, and depression. High pain intensity at the time of trauma has been identified as a risk factor for chronic pain, but the precise level of minimum pain intensity or severity of unrelieved pain that leads to chronic pain is unknown. Furthermore, the incidence of pain hypersensitivity in trauma patients after recovery from the injury is not well documented. The purpose of this study is to test whether unrelieved post-trauma pain is associated with chronic pain and pain hypersensitivity to subsequent painful stimuli following lower extremity trauma. The proposed study will: (1) identify and describe how pain threshold, duration, and timing effects at time of traumatic injury are associated with chronic pain following lower extremity trauma and, (2) test whether neuronal changes from central sensitization are present in this population. Aim 1 will examine how unrelieved acute pain after lower extremity trauma correlates with chronic pain by a retrospective review of medical records of adult trauma patients to examine patterns, intensity of pain ratings, and analgesic use during hospitalization after injury. For Aim 2, a subset of participants from Aim 1 will be classified into one of four groups based on the mean pain score during the first 24 hours of hospital admission: (1) mean pain score <2, no chronic pain, (2) mean pain score >2, no chronic pain, (3) mean pain score <2, chronic pain, (4) mean pain score >2, chronic pain. A group of age/gender-matched trauma-naive participants will be included as normative controls. Assessments for central neuronal plasticity changes due to central sensitization will be completed: Quantitative Sensory Testing to measure pain hypersensitivity, Current Perception Threshold testing to measure sensory fiber function, Conditioned Pain Modulation to assess diffuse noxious inhibitory control, and Pressure Pain Threshold to assess mechanical pain sensitivity. The training outlined in this proposal will augment previous training initiated by the applicant in her goal to become an independent nurse scientist with a research program focusing on underlying biological mechanisms associated with chronic pain. Chronic pain research aligns well with the NINR mission to identify underlying biological bases of symptoms (e.g., pain) that interfere with patient quality of life. Training wil focus on: (1) increasing the applicant's knowledge base of pathophysiology of chronic pain; (2) enrich her methodological and analytical skills related to clinical research, and (3) successful dissertation defense and improved grant and manuscript writing skills. Study findings may contribute to development of new therapeutic strategies to decrease chronic pain.