CAPSITE: Community Assessment of Pain and Sensitization in the Elderly

CAPSITE：老年人疼痛和敏感度的社区评估

• 批准号: 10549323
• 负责人: Emelia J. Benjamin
• 金额: $ 64.95万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10549323
• 关键词: Abdominal Pain; Address; Admission activity; Adult; Affect; Age; Aging; American; Anatomy; Arthralgia; Back Pain; Body part; Cessation of life; Chronic; Communities; Data; Degenerative polyarthritis; Development; Diagnosis; Disease; Elderly; Epidemiologist; Epidemiology; Evaluation; Evolution; Framingham Heart Study; Frequencies; Grant; Health; Health Personnel; Incidence; Institutionalization; International; Knowledge; Location; Measures; Migraine; Nursing Homes; Pain; Pain Measurement; Pain management; Pathway interactions; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Persistent pain; Physical Function; Prevalence; Preventive; Psychologist; Public Health; Risk; Risk Factors; Sensory; Severities; Site; Specialist; Subjects Selections; Testing; Therapeutic; Time; Visit; Work; chronic pain; chronic painful condition; cohort; conditioned pain modulation; cost estimate; disability; experience; follow up assessment; human old age (65+); innovation; insight; interdisciplinary collaboration; mortality; mortality risk; multidisciplinary; neurophysiology; novel; opioid epidemic; pain processing; rheumatologist; surveillance study; treatment response

Chronic pain affects over 100 million American adults and >40% of older adults age ≥65, with estimated costs of >$500 billion to $1 trillion annually. 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, and in turn, to the opioid epidemic. 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 adults, nor of the impact of COPC on physical function, risk of nursing home admission, and mortality in older adults. We propose to evaluate chronic pain in the upcoming study visit of a thoroughly-characterized community-based older adult cohort unselected for any pain complaints, the Framingham Heart Study (FHS) (N~1874, mean age 76, 84% ≥age 70). 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 as risk factors for COPC and its evolution, 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 and response to treatment in experimental settings of subjects selected for particular pain conditions. However, whether QST- assessed neurophysiologic alterations may be common underlying risk factors for all forms of chronic pain, and for functional limitations, institutionalization, and mortality in a community-based cohort of older adults unselected for pain is unknown. We will collect data regarding a multitude of chronic pain conditions, QST, self-report and performance-based physical 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 FHS 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.

慢性疼痛影响超过1亿美国成年人，> 40％的老年人≥65岁，估计成本 每年> 5000亿美元至1万亿美元。老年人患有多个痛苦状况的风险增加， 慢性疼痛的负面影响更长。慢性疼痛，无论解剖学或诊断如何 参与（例如，背痛，偏头痛）是全球残疾的主要原因。关于是否有限的见解 不论诊断如何，所有疼痛状况的常见机制都导致疼痛不足 管理选择，反过来归因于阿片类药物流行。治疗一种疼痛状况的医疗保健提供者 （例如，关节疼痛）通常不治疗身体其他部位的症状（例如腹痛）和患者 通常是从一位专家转介到另一个专家。研究各种慢性重叠疼痛的共同点 未针对疼痛条件选择的基于社区的队列中的条件（COPC）可以为您提供新颖的见解 慢性疼痛作为疾病本身的原因和后果。例如，疼痛的神经生理改变 处理诸如疼痛敏感性（评估上升疼痛途径）和调节疼痛调节之类的处理 （CPM）（评估下降疼痛调节）可能是所有慢性疼痛的常见机制。这样的 知识将刺激各种疼痛的新型疼痛管理方法的发展 解剖学或诊断。尽管慢性疼痛遭受了大量的公共卫生烧伤，但对 老年人COPC的流行病学和进化，也没有COPC对身体机能的影响， 老年人的疗养院入学和死亡率。我们建议评估即将到来的慢性疼痛 彻底表征社区的老年人同队的研究访问未选择任何疼痛抱怨， Framingham心脏研究（FHS）（N〜1874，平均年龄76，84％≥1Age70）。我们旨在了解 COPC的流行病学，无论涉及的解剖学或诊断如何，COPC随时间的演变， 疼痛处理的神经生理改变是COPC及其演变的危险因素，以及 COPC和老年人的疼痛处理改变。我们提出了准目标定量感觉测试 （QST）疼痛敏感性和CPM的度量，与疼痛严重程度和对 在选择特定疼痛条件的受试者的实验环境中进行治疗。但是，是否qst- 评估的神经生理改变可能是所有形式的慢性疼痛的常见危险因素，并且 在一个未选择的社区的老年人队列中，用于功能限制，制度化和死亡率 因为疼痛是未知的。我们将收集有关多种慢性疼痛状况，QST，自我报告和 基于绩效的身体机能，以及在下一次计划学习访问期间的护理家庭入学 作为两项随访评估，以获得纵向数据，并利用正在进行的FHS死亡率监视。 我们的工作将解决一些知识差距，而获得的见解最终可能有助于新的预防性和 无论诊断如何，都可以缓解慢性疼痛及其后果的治疗方法。