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.

在这项提案中，我们的生物行为疼痛研究团队与约翰·霍普金斯大学合作 由成人 SCD 研究人员组成的医院团队应对令人难以置信的疼痛挑战 SCD 中的管理。尽管临床结果存在巨大的个体差异 在 SCD 患者中，几乎每天都会经历明显的疼痛， 目前对于 SCD 的疼痛表型以及这些表型如何发生知之甚少 预测临床结果。我们的团队力图证明个体差异 SCD 中出现疼痛表型，对疼痛的炎症/免疫反应有助于 这些疼痛表型可以预测重要的临床结果 在SCD中。我们提出两项连续研究：研究 1 将描述疼痛表型的特征 使用情绪、性格和与疼痛相关的灾难化措施以及 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 针对 SCD，实验室疼痛处理措施将在 非裔美国成年 SCD 患者和一组匹配的健康非裔美国人 成年人。为了确定该方法的临床实用性和预测有效性 实验室引起的炎症/免疫反应、炎症水平和 需要住院治疗的血管闭塞危机 (VOC) 期间的免疫反应将 在 SCD 患者中进行了检查。研究 2 将确定疼痛表型是否 前瞻性预测 SCD 的临床结果。临床结果的测量将 包括平均每天的疼痛、VOC 的频率和严重程度，以及非定期使用 疼痛管理的医疗保健。研究 2 参与者的医疗记录数据 入住约翰·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。有能力 确定标准化措施，例如疼痛敏感性、疼痛诱发 炎症/免疫反应和心理社会因素，有助于解释患者的症状 临床过程，特别是他们对阿片类药物治疗的反应，将会产生戏剧性的变化。 影响医疗保健提供者如何处理这些患者的疼痛。