Applying Biopsychosocial Model to Post-MVC Pain Development in African Americans

将生物心理社会模型应用于非裔美国人 MVC 后疼痛的发展

• 批准号: 8683850
• 负责人: SAMUEL A. MCLEAN
• 金额: $ 5.35万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8683850
• 关键词: Accident and Emergency department; Acute Pain; Adrenergic Agents; Affect; African American; Aftercare; American; Behavioral; Catecholamines; Chronic; Chronic neck pain; Cognitive; Constitutional; Data; Development; Discrimination; Disease; Enzymes; Equation; Etiology; European; Evaluation; Frequencies; Fright; Genetic; Genetic Predisposition to Disease; Genetic Variation; Home environment; Incidence; Individual; Injury; Interview; Knowledge; Mental Depression; Minor; Modeling; Musculoskeletal Pain; Neck Pain; Nervous system structure; Outcome; Pain; Participant; Pathogenesis; Perception; Persistent pain; Physiological; Process; Public Health; Recovery; Recruitment Activity; Reporting; Research; Research Personnel; Rheumatism; Role; Severities; Shapes; Site; Societies; Stress; Synapses; System; Testing; Vehicle crash; adrenergic; adverse outcome; biological adaptation to stress; biopsychosocial; chronic pain; cohort; disability; economic impact; ethnic discrimination; expectation; experience; follow-up; genetic variant; prospective; psychologic; response

DESCRIPTION (provided by applicant): Approximately 6 million Americans present to US Emergency Departments (ED) each year for care after motor vehicle collision (MVC). More than 90% of these individuals do not have serious physical injury and are discharged to home after ED evaluation. Persistent musculoskeletal pain develops in 10-20% of European Americans (EA) who experience such MVCs, with an economic impact of $29 billion per year in the US alone. The incidence of chronic pain development in African Americans (AA) experiencing MVC has never been reported. However, substantial evidence (and the investigator's pilot data) indicate that AA experience an increased burden of chronic pain. Reasons for this increased burden are poorly understood. Mechanisms of chronic musculoskeletal pain pathogenesis after MVC are described in biopsychosocial models, most notably Vlaeyen's fear-avoidance model (FAM), which is supported by substantial research. Experiences of discrimination may influence FAM processes and contribute to an increased incidence of chronic pain in AA experiencing MVC via a number of mechanisms. For example, discrimination experiences may: (1) cause stress-induced physiologic changes which increase initial pain in response to MVC, (2) increase subsequent depression and disability, and (3) increase chronic pain vulnerability in response to disability and depression. In addition, past adverse outcomes related to discrimination may increase negative expectations after MVC, which in turn may worsen pain-related outcomes. Available data suggest that the strength of an individual's ethnic identification may moderate these discrimination influences. To date, the FAM has never been evaluated in a cohort of AA transitioning to recovery vs. persistent pain, and the influence of discrimination and ethnic identity on FAM mechanisms has never been assessed. In addition, the influence of genetic vulnerability factors on FAM concepts and processes has rarely been evaluated, and never in AA. Evaluating genetic factors which influence the function of a physiologic system affecting FAM processes can advance our understanding of how constitutional factors interact with cognitive, psychological, and experiential factors to shape pain outcomes. The adrenergic nervous system is an excellent physiologic system to assess in this regard, because of its importance in pain perception, its critical role in the stress response, and its demonstrated interaction with FAM processes during chronic pain development. The proposed study will recruit one thousand AA presenting to a research network of ED sites after minor MVC. Participants will receive initial ED evaluation and follow-up interviews at 6 weeks and 6 and 12 months. Structural equation modeling will be used to test the multivariate predictive relationships described in the FAM. The influence of experiences of discrimination and ethnic identity on specific FAM concepts and processes will also be assessed, as will the influence of genetic factors affecting adrenergic system function. Together, the results of these analyses will substantially advance our knowledge of chronic pain pathogenesis in AA.

描述（由申请人提供）：每年约有 600 万美国人在机动车碰撞 (MVC) 后前往美国急诊室 (ED) 寻求护理。其中 90% 以上的人没有严重的身体伤害，并在 ED 评估后出院回家。经历此类 MVC 的欧洲裔美国人 (EA) 中 10-20% 会出现持续性肌肉骨骼疼痛，仅在美国每年就会造成 290 亿美元的经济影响。经历 MVC 的非裔美国人 (AA) 发生慢性疼痛的发生率从未有过报道。然而，大量证据（以及研究者的试验数据）表明，AA 的慢性疼痛负担增加。人们对这种负担增加的原因知之甚少。 MVC 后慢性肌肉骨骼疼痛的发病机制在生物心理社会模型中得到描述，最著名的是 Vlaeyen 的恐惧回避模型 (FAM)，该模型得到了大量研究的支持。歧视经历可能会影响 FAM 过程，并通过多种机制导致经历 MVC 的 AA 中慢性疼痛的发生率增加。例如，歧视经历可能：（1）导致压力诱发的生理变化，增加对 MVC 的初始疼痛，（2）增加随后的抑郁和残疾，以及（3）增加对残疾和抑郁的慢性疼痛脆弱性。此外，过去与歧视相关的不良结果可能会增加 MVC 后的负面期望，进而可能恶化与疼痛相关的结果。现有数据表明，个人种族认同的强度可能会减轻这些歧视的影响。迄今为止，FAM 从未在 AA 过渡到恢复与持续疼痛的队列中进行过评估，并且歧视和种族认同对 FAM 机制的影响也从未被评估过。此外，遗传脆弱性因素对 FAM 概念和过程的影响很少被评估，在 AA 中也从未评估过。评估影响 FAM 过程的生理系统功能的遗传因素可以增进我们对体质因素如何与认知、心理和经验因素相互作用以形成疼痛结果的理解。肾上腺素能神经系统是在这方面进行评估的绝佳生理系统，因为它在疼痛感知中的重要性、在应激反应中的关键作用以及在慢性疼痛发展过程中与 FAM 过程的相互作用。拟议的研究将招募 1000 名 AA，在轻微 MVC 后向 ED 站点的研究网络进行展示。参与者将在第 6 周、第 6 个月和第 12 个月时接受初步 ED 评估和后续访谈。结构方程模型将用于测试 FAM 中描述的多元预测关系。还将评估歧视经历和种族认同对特定 FAM 概念和过程的影响，以及影响肾上腺素能系统功能的遗传因素的影响。总之，这些分析的结果将极大地增进我们对 AA 慢性疼痛发病机制的了解。