Biopsychosocial Influence on Shoulder Pain

生物心理社会对肩痛的影响

基本信息

批准号：
9695927
负责人：
STEVEN Z GEORGE
金额：
$ 61.28万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-01 至 2022-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9695927
关键词：
Address Adrenergic Agents Adrenergic beta-Antagonists Catechol O-Methyltransferase Catecholamines Characteristics Clinical Clinical Trials Cognitive Complex Data Development Enzymes Etiology Exercise Foundations Fright Funding Genetic Genetic Polymorphism Genotype Goals Haplotypes Individual Inflammatory Injury Institute of Medicine (U.S.)Interdisciplinary Study Intervention Intervention Studies Link Measures Medical Methodology Methyltransferase Gene Modeling Molecular Musculoskeletal Pain Opioid Outcome Pain Pain intensity Pain management Pathway interactions Patients Perception Pharmacologic Substance Phase Pilot Projects Placebos Population Postoperative Period Pre-Clinical Model Predictive Factor Propranolol Psychological Factors Randomized Regulation Research Resources Risk Risk Factors Sampling Scientific Advances and Accomplishments Shoulder Pain Societies Standardization Subgroup System Translating United States Upper Extremity base biopsychosocial chronic musculoskeletal pain chronic shoulder pain cohort cytokine design disability economic impact enzyme activity experience genetic variant health care delivery high risk individualized medicine pain catastrophizing pain inhibition pain model pain perception pain relief pain sensitivity personalized intervention personalized medicine pre-clinical prevent psychologic public health relevance response shoulder injury standard of care therapy design

项目摘要

? DESCRIPTION (provided by applicant): Treatment tailored to specific patient characteristics (i.e. personalized medicine) will have a significant positive impact on the delivery of healthcare. Personalized medicine for musculoskeletal pain conditions is a high priority because these conditions are a heavy burden to society due their economic impact and suffering they cause. Therefore, the ultimate goal of this line of research is to develop personalized interventions for musculoskeletal pain that ameliorate musculoskeletal pain and lessen their burden on society. We study shoulder pain because it is a common musculoskeletal pain condition and in the initial funding period we identified combinations of genetic and psychological risk factors indicative of chronic shoulder pain. In particular, a combination of COMT genetic variants and pain catastrophizing formed a high risk subgroup predictive of heightened shoulder pain responses in a pre-clinical exercise-induced injury cohort and poor 12 month outcomes in a clinical post-operative shoulder pain cohort. This promising and robust finding provided the impetus to transition this line of research to an intervention phase. The renewal application will provide resources for this multidisciplinary research team to determine mechanisms and efficacy of personalized pharmaceutical and psychological pain interventions designed to target genetic and psychological factors that comprise the high risk subgroup. The pharmaceutical intervention will be propranolol as it counters the effects of decreased COMT enzyme. The psychological intervention will be cognitive restructuring that lessen the impact of pain catastrophizing. Our primary hypothesis is that subjects receiving the combined personalized pharmaceutical and personalized psychological intervention will have decreased shoulder pain duration, peak pain intensity, and peak upper-extremity disability following exercise-induced shoulder injury, when compared to the combined placebo condition. In addition, we will investigate psychological, molecular, and pain sensitivity regulation as mechanisms of pain relief. Successful completion of the proposed study will have a strong impact on the field as it has the potential to alter standard of care by discovering effective personalized pain treatments for individuals that, without the treatments, would go on to develop chronic shoulder pain. Completion of this study will also provide critical foundational data for designing a subsequent clinical trial in a post-operative shoulder pain cohort.

？描述（由申请人提供）：针对特定患者特征的治疗（即个性化医疗）将对医疗保健的提供产生显着的积极影响。针对肌肉骨骼疼痛的个性化医疗是当务之急，因为这些疾病因其经济影响和造成的痛苦而给社会带来沉重负担。因此，这一系列研究的最终目标是开发针对肌肉骨骼疼痛的个性化干预措施，以减轻肌肉骨骼疼痛并减轻其对社会的负担。我们研究肩部疼痛是因为它是一种常见的肌肉骨骼疼痛状况，并且在最初的资助期间，我们确定了指示慢性肩部疼痛的遗传和心理危险因素的组合。特别是，COMT 基因变异和疼痛灾难化的组合形成了一个高风险亚组，预测临床前运动引起的损伤队列中肩部疼痛反应加剧，以及临床术后肩部疼痛队列中 12 个月结果不佳。这一有希望且强有力的发现为将这一研究方向过渡到干预阶段提供了动力。更新申请将为这个多学科研究团队提供资源，以确定个性化药物和心理疼痛干预措施的机制和功效，这些干预措施旨在针对构成高风险亚组的遗传和心理因素。药物干预将是普萘洛尔，因为它可以对抗 COMT 酶减少的影响。心理干预将是认知重建，以减轻灾难性疼痛的影响。我们的主要假设是，与联合安慰剂条件相比，接受个性化药物和个性化心理干预相结合的受试者在运动引起的肩部损伤后，肩部疼痛持续时间、疼痛峰值强度和上肢残疾峰值将减少。此外，我们将研究心理、分子和疼痛敏感性调节作为缓解疼痛的机制。拟议研究的成功完成将对该领域产生重大影响，因为它有可能通过发现有效的个性化疼痛治疗方法来改变护理标准，这些治疗方法适用于那些如果没有治疗就会继续发展为慢性肩痛的个体。这项研究的完成还将为设计术后肩痛队列的后续临床试验提供关键的基础数据。

项目成果

期刊论文数量（16）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Investigation of central pain processing in postoperative shoulder pain and disability.

术后肩痛和残疾中枢疼痛处理的研究。

DOI：
10.1097/ajp.0000000000000029
发表时间：
2014
期刊：
The Clinical journal of pain
影响因子：
0
作者：
Valencia,Carolina;Fillingim,RogerB;Bishop,Mark;Wu,SamuelS;Wright,ThomasW;Moser,Michael;Farmer,Kevin;George,StevenZ
通讯作者：
George,StevenZ

Psychologic influence on experimental pain sensitivity and clinical pain intensity for patients with shoulder pain.

DOI：
10.1016/j.jpain.2008.09.004
发表时间：
2009-03
期刊：
The journal of pain
影响因子：
0
作者：
George SZ;Hirsh AT
通讯作者：
Hirsh AT

Chronic Pain Prevalence and Factors Associated With High Impact Chronic Pain following Total Joint Arthroplasty: An Observational Study.

DOI：
10.1016/j.jpain.2021.09.007
发表时间：
2022-03
期刊：
JOURNAL OF PAIN
影响因子：
4
作者：
George, Steven Z.;Bolognesi, Michael P.;Bhavsar, Nrupen A.;Penrose, Colin T.;Horn, Maggie E.
通讯作者：
Horn, Maggie E.

Testing for efficacy in adaptive clinical trials with enrichment.