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（由申请人提供）：创伤后应激障碍（PTSD）和慢性疼痛非常普遍，并且都与长期残疾和虐待有关，给个人和社会带来巨大的情感、功能和经济损失。重叠在 20% 到 70% 之间，代表着一个巨大的公共卫生问题。然而，我们对 PTSD 和慢性疼痛交织的机制的理解是有限的。共病是横断面的，集中于单一的慢性疼痛病症，慢性疼痛也与药物滥用的高发生率有关。复原力和脆弱性因素导致从急性疼痛向慢性疼痛的转变，并且药物滥用的发展需要前瞻性设计，此类研究对于市中心的非裔美国女性至关重要，她们更有可能经历创伤性压力和疼痛，但不太可能经历。也许是一种现象；导致更大的残疾和药物滥用风险，我们建议在 6-6 个月的时间里检查与 PTSD/慢性疼痛配对和药物滥用相关的 3 种模型。第一个是主效应模型，其中基线时的 PTSD 症状水平将预测 6 个月时从急性疼痛转变为药物滥用的可能性；第二个是调节模型，其中基线脆弱性和复原力因素与 PTSD 症状相互作用预测 6 个月后慢性疼痛和药物滥用的可能性 第三个是中介模型，其中 PTSD 症状的基线水平与 6 个月后慢性疼痛和药物滥用的发展之间的关系由 3 个月时发展的脆弱性和复原力因素介导。仅招募患有急性骨盆/腹部、颈部/肩部或腰部疼痛的 18-40 岁内城女性 (N=600)。我们将评估 3 波（基线、3 和 6）的创伤暴露、PTSD 症状、疼痛敏感性、物质依赖和滥用、急性疼痛和社会心理弹性以及脆弱性因素。 -个月），并在 1、2、4 和 5 个月时获得额外的疼痛强度和干扰评估。选择内城妇女是因为她们极有可能遭受持续的创伤事件，并且有机会遭受创伤。照亮健康创伤后应激障碍 (PTSD) 与慢性疼痛配对的差异，尤其是内城区少数族裔女性之间的差异 共病创伤后应激障碍 (PTSD)、慢性疼痛和药物滥用所带来的公共卫生问题怎么强调都不为过，特别是因为它影响了美国的健康差异。创伤后应激障碍（PTSD）如何增加从急性疼痛转变为慢性疼痛和发展药物滥用的可能性，哪些因素导致这些发展，以及哪些人可能最脆弱，这将允许对准确确定的目标进行更及时的临床干预，以帮助预防这些发展棘手的条件。