Clinical Implications of Pain Phenotypes in Sickle Cell Disease

镰状细胞病疼痛表型的临床意义

• 批准号: 8134878
• 负责人: JENNIFER A HAYTHORNTHWAITE
• 金额: $ 46.03万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-20 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8134878
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Adult; Affect; African American; Age; American; Analgesics; Anxiety; Caring; Characteristics; Chronic; Clinical; Cohort Studies; Controlled Environment; Data; Dimensions; Education; Electronics; Female; Frequencies; Goals; Guidelines; Health Personnel; Healthcare; Healthcare Systems; Home environment; Hospitals; Hour; IL8 gene; Immune response; Individual; Individual Differences; Inflammation; Inflammatory; Infusion procedures; Interleukin-6; Ischemia; Knowledge; Laboratories; Life Expectancy; Matched Group; Measures; Medical; Medical Records; Methods; Monitor; Moods; Morphine; Neuraxis; Nociception; Opioid; Organ; Outcome; Pain; Pain Threshold; Pain management; Participant; Patient Self-Report; Patients; Personality; Pharmaceutical Preparations; Phenotype; Play; Process; Process Measure; Provider; Psychosocial Factor; Quality of life; Race; Reflex action; Regimen; Reporting; Research Personnel; Risk Factors; Role; Severities; Sickle Cell; Sickle Cell Anemia; Structure; Substance P; Telephone; Testing; Tissues; Trust; base; biobehavior; chronic pain; diaries; diffuse noxious inhibitory control; disease phenotype; experience; indexing; interest; pain inhibition; prospective; psychosocial; racial difference; response; sex; spinal reflex; standardize measure; treatment duration

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.

在此提案中，我们的生物行为疼痛研究人员团队加入了约翰·霍普金斯（Johns Hopkins） 成人SCD研究人员的医院团队，以应对令人难以置信的痛苦挑战 SCD的管理。尽管临床结果上有很大的个体差异 在SCD的患者和几乎每天疼痛的清晰广泛经验中， 目前，关于SCD中的疼痛表型以及这些表型如何了解 预测临床结果。我们的团队试图证明个人差异 疼痛表型发生在SCD中，炎症/免疫反应对疼痛的反应促进 对于这些表型，这些疼痛表型预测了重要的临床结果 在SCD中。我们提出了两个顺序研究：研究1将表征疼痛表型 使用情绪，个性和与疼痛相关的灾难性的度量 基于实验室的疼痛处理，包括疼痛敏感性和疼痛诱发 炎症/免疫反应。为了确定这些疼痛表型是否 特定于SCD，将比较实验室疼痛处理措施 非裔美国人成人SCD患者和一组匹配的健康非裔美国人 成年人。为了确定临床效用和预测有效性 在实验室引起的炎症/免疫反应，炎症水平和 在需要医院护理的血管熟悉危机（VOC）期间的免疫反应将是 在SCD患者中检查。研究2将确定疼痛表型是否 前瞻性预测SCD中的临床结果。临床结局的度量将 包括平均每日疼痛，VOC的频率和严重程度以及计划外的使用 疼痛管理的医疗保健。研究2参与者的病历数据 被接纳为约翰·霍普金斯医院镰状细胞输注中心 将检查VOC的管理以确定阿片类药物的反应性。能力 确定标准化的措施，例如疼痛敏感性，疼痛诱发 炎症/免疫反应和社会心理因素，有助于解释患者 临床过程，尤其是他们对阿片类药物疗法的反应，将有一个戏剧性的 对医疗保健提供者如何处理这些患者的疼痛管理的影响。