Development of Co-Morbid PTSD and Chronic Pain Among Inner-City Women

内城区女性共病创伤后应激障碍 (PTSD) 和慢性疼痛的发展

• 批准号: 9490306
• 负责人: John W. Burns
• 金额: $ 57.75万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9490306
• 关键词: Abdomen; Accident and Emergency department; Acute; Acute Pain; African American; Age; Assessment tool; Clinical; Comorbidity; Development; Diagnosis; Disease; Emotional; Enrollment; Exposure to; High Prevalence; Individual; Intervention; Light; Link; Low Back Pain; Mediating; Mediation; Mediator of activation protein; Minority; Modeling; Neck; Pain; Pain Measurement; Pain intensity; Pain interference; Pelvis; Population Study; Post-Traumatic Stress Disorders; Prospective Studies; Public Health; Questionnaires; Recording of previous events; Reporting; Research; Risk; Selection for Treatments; Shoulder; Societies; Stress; Substance Addiction; Substance abuse problem; Symptoms; Telephone; Testing; Time; Trauma; Woman; chronic pain; chronic painful condition; design; disability; experience; health disparity; inner city; pain sensitivity; prospective; psychosocial; public health relevance; recruit; resilience; trauma exposure; traumatic event

 DESCRIPTION (provided by applicant): PTSD and chronic pain are highly prevalent and each is associated with long-term disability and substance abuse, exacting enormous emotional, functional, and financial tolls on individuals and society. PTSD and chronic pain are frequently co-morbid with overlap between 20% and 70%, representing an enormous public health problem. However, our understanding of the mechanisms by which PTSD and chronic pain become intertwined is limited. The majority of studies of the PTSD/chronic pain co-morbidity are cross- sectional, and focused on a single chronic pain condition, limiting causal inferences and generalizability to other chronic pain conditions. Chronic pain is also related to a high prevalence of substance abuse. To understand how trauma-related PTSD, and resilience and vulnerability factors contribute to the transition from acute to chronic pain and development of substance abuse requires prospective designs. Such research is vital among inner-city African American women, who are more likely to experience traumatic stress and pain, but are less likely to be treated appropriately; a phenomenon perhaps leading to greater risk for disability and substance abuse. We propose to examine 3 models related to the development of PTSD/chronic pain pairing and development of substance abuse in people initially presenting with acute pain (not caused by a traumatic event) in a 6-month prospective design. First is the Main Effects Model in which the level of PTSD symptoms at baseline will predict the likelihood of a transition from acute to chronic pain and development of substance abuse at 6 months. Second is the Moderation Model in which baseline vulnerability and resilience factors interact with PTSD symptoms to predict the likelihood of developing chronic pain and substance abuse 6 months later. Third is the Mediator Model in which relationships between baseline levels of PTSD symptoms and the development of chronic pain and substance abuse 6 months later are mediated by vulnerability and resilience factors at 3 months. Inner-city women (N=600) presenting to an Emergency Department with a complaint of acute bodily pain, ages 18-40 yrs, will be recruited. Only women presenting with acute pelvic/abdominal, neck/shoulder or low back pain, and who do not have a chronic pain history will be enrolled. We will assess trauma exposure, PTSD symptoms, pain sensitivity, substance dependence and abuse, acute pain and psychosocial resilience and vulnerability factors across 3 waves (baseline, 3- and 6-months), and obtain additional phone assessment of pain intensity and interference at 1-, 2-, 4-, and 5-months. Inner-city women were chosen because of their high likelihood of exposure to ongoing traumatic events and the opportunity to illuminate a health disparity involving the PTSD/chronic pain pairing among inner-city minority women in particular. The public health problem posed by co-morbid PTSD, chronic pain and substance abuse cannot be overstated, particularly as it impacts health disparities in the US. Greater understanding of how PTSD may increase the likelihood of transitioning from acute to chronic pain and developing substance abuse, which factors contribute to these developments, and which people may be most vulnerable will allow more timely clinical interventions on accurately identified targets to help forestall the development of these largely intractable conditions.

 描述（由适用提供）：PTSD和慢性疼痛非常普遍，每种疼痛都与长期残疾和滥用药物相关，对个人和社会造成了巨大的情感，功能和财务上的巨大伤害。 PTSD和慢性疼痛经常与20％至70％的重叠合并，这是一个巨大的公共卫生问题。但是，我们对PTSD和慢性疼痛交织的机制的理解是有限的。 PTSD/慢性疼痛合并症的大多数研究都是横断面的，并集中在单个慢性疼痛状态上，限制了催化推断和对其他慢性疼痛状况的普遍性。慢性疼痛也与滥用药物的高流行有关。要了解与创伤相关的PTSD以及弹性和脆弱性因素如何有助于从急性到慢性疼痛和滥用药物的发育过渡。在非洲裔美国妇女中，这种研究至关重要，她们更有可能遭受创伤性压力和疼痛，但不太可能得到适当的治疗。一种现象可能导致更大的残疾和滥用药物的风险。我们建议研究3个模型，这些模型与最初在6个月的前瞻性设计中最初出现急性疼痛（不是由创伤事件引起的）的人的PTSD/慢性疼痛配对和滥用药物滥用的发展有关。首先是主要影响模型，在基线时，PTSD症状水平将预测从急性到慢性疼痛和6个月滥用药物滥用的发展的可能性。第二是节制模型，在该模型中，基线脆弱性和弹性因素与PTSD症状相互作用，以预测6个月后出现慢性疼痛和药物滥用的可能性。第三是调解人模​​型，其中PTSD症状的基线水平与6个月后的慢性疼痛和药物滥用的发展之间的关系是由3个月时脆弱性和韧性因素介导的。将招募向急诊室提出急性身体疼痛的内城妇女（n = 600），年龄在18-40岁之间。只有出现急性骨盆/腹部，颈部/肩膀或腰痛，并且没有慢性疼痛病史的女性才会被纳入。我们将评估创伤暴露，PTSD症状，疼痛敏感性，物质依赖性和滥用，急性疼痛和社会心理韧性以及跨3波（基线，3个和6个月）的脆弱性因素，并获得1-，2，4-，4-和5个月的疼痛强度和干扰的其他电话评估。之所以选择城市妇女，是因为她们暴露于正在进行的创伤事件的可能性很大，并有机会阐明涉及PTSD/慢性疼痛涉及的健康差异，尤其是在城市内部少数民族中。联合PTSD构成的公共卫生问题，慢性疼痛和药物滥用不能被夸大，尤其是因为它影响了美国的健康差异。对PTSD如何增加从急性到慢性疼痛和发展底物滥用的可能性更大的可能性，这会导致这些发展，而人们可能最脆弱的人将允许对准确识别的目标进行更及时的临床干预，以帮助详细列出这些疾病的发展。