Characterization of Chronic Pain and its Biopsychosocial Mechanisms in Lupus using Electronic Health Records

使用电子健康记录描述狼疮慢性疼痛及其生物心理社会机制

基本信息

批准号：
10406326
负责人：
Titilola Falasinnu
金额：
$ 12.63万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-19 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10406326
关键词：
Affect Algorithms American Analgesics Award Behavioral Chronic Chronic Disease Clinic Clinical Clinical Decision Support Systems Clinical Management Clinical Research Code Communication Computational algorithm Computing Methodologies Data Deterioration Development Diagnostic Disease Educational workshop Electronic Health Record Epidemic Epidemiologist Female Future General Population Geography Goals Grant Health Healthcare Systems Hospitalization Individual Inflammatory Investments K-Series Research Career Programs Knowledge Knowledge Management Lupus Machine Learning Measures Medicine Mentors Mentorship Methods Mission Modeling Moods Natural History Natural Language Processing Outcome Pain Pain Clinics Pain Research Pain management Patient Self-Report Patients Persistent pain Persons Pharmaceutical Preparations Phenotype Population-Based Registry Prevalence Principal Investigator Public Health Publishing Registries Research Research Personnel Research Training Rheumatism Rheumatology Risk Risk Factors Science Sensitivity and Specificity Sleep Structure Subgroup Symptoms Systemic Lupus Erythematosus Techniques Testing Time Training Translating United States United States National Institutes of Health Woman Writing addiction biomedical informatics biopsychosocial body map career chronic pain chronic pain management clinical decision support clinically significant comorbidity cost data registry diagnostic accuracy effective therapy experience improved mortality multidisciplinary opioid misuse opioid overdose opioid use pain catastrophizing pain reduction pain score patient stratification phenotyping algorithm post-doctoral training prescription opioid profiles in patients psychologic psychosocial racial minority skills social sociodemographic variables socioeconomics structured data support tools symposium targeted treatment tenure track text searching unstructured data

项目摘要

Up to 100 million Americans live with ongoing pain, costing $635 billion annually. In the United States, there are more than 200,000 people living with SLE, a chronic inflammatory rheumatic disease with multi-organ involvement that disproportionately affects females and racial minorities. Living with a chronic disease such as SLE confers multiple challenges. Pain is a frequent self-reported symptom in SLE and is often one of the first symptoms of the disease. Despite treatment advances, pain remains the most prominent, unaddressed patient complaint. The management of pain in SLE has recently become more challenging because of the alarming epidemic of addiction and mortality attributed to opioid misuse. An estimated 31-46% of patients with SLE use prescription opioids. In one study, 70% of individuals using opioids used them for ≥1 year, and 22% were taking ≥2 opioid medications at the same time. Patients with SLE are nearly twice as likely as the general population to have opioid-related overdose hospitalizations. However, efforts to mitigate opioid misuse cannot be achieved without a detailed understanding and sustained investment in clinical research on the underlying mechanisms that produce and maintain chronic pain. Characterizing the burden of chronic pain in SLE is challenging on at least two counts. First, we lack data on the prevalence and burden of chronic pain in SLE, partly due to the absence of reliable approaches to identify patients with clinically significant pain in electronic health records (EHR). Second, there is a critical need to understand the biopsychosocial mechanisms and correlates that drive the pain experience in SLE. In this mentored career development award (K01), Dr. Titilola Falasinnu will use computational methods to increase the understanding of the clinical management chronic pain in SLE using EHR. In Aim 1, Dr. Falasinnu will develop a computational chronic pain phenotyping algorithm using diagnostic codes, pain scores, narrative clinic notes and medications extracted from the EHRs of two large healthcare systems (n~2,400). She will then use the algorithm to estimate chronic pain prevalence in a population-based registry (n~76,000). In Aim 2, Dr. Falasinnu will comprehensively phenotype biopsychosocial correlates of chronic pain using an existing registry of ~500 patients with SLE attending a multi-disciplinary pain center. Throughout the award, Dr. Falasinnu will build on her doctoral training as an epidemiologist and biostatistician to develop new skills in biomedical informatics to conduct impactful pain medicine research. These skills will include working with EHR and registry data, machine learning and natural language processing, pain science, grant-writing, and scientific communication. Through coursework, clinical observation in pain medicine clinics, mentorship, and external conferences and workshops, Dr. Falasinnu will gain the skills needed to apply for her first R01 and pursue a career as a tenure-track principal investigator.

多达 1 亿美国人承受持续的痛苦，每年造成 6,350 亿美元的损失。超过 200,000 人患有 SLE，这是一种累及多器官的慢性炎症性风湿病参与对女性和少数族裔的影响尤为严重，例如患有慢性疾病。系统性红斑狼疮带来多重挑战。疼痛是系统性红斑狼疮中常见的自我报告症状，而且通常是首先出现的症状之一。尽管治疗取得了进展，但疼痛仍然是最突出且尚未得到解决的患者。由于令人震惊的症状，SLE 疼痛的治疗最近变得更具挑战性。据估计，31-46% 的 SLE 患者使用阿片类药物导致成瘾和死亡。在一项研究中，70% 的阿片类药物使用时间≥1 年，22% 的人使用阿片类药物。同时服用≥2种阿片类药物的患者患SLE的可能性几乎是一般人的两倍。然而，减少阿片类药物滥用的努力无法实现。无需对基础临床研究进行详细了解和持续投资即可实现产生和维持慢性疼痛的机制是 SLE 慢性疼痛负担的特征。至少在两个方面具有挑战性，首先，我们缺乏有关 SLE 慢性疼痛的患病率和负担的数据，部分原因是缺乏可靠的方法来识别电子设备中具有临床显着疼痛的患者其次，迫切需要了解生物心理社会机制和健康记录。 Titilola 博士在这项指导性职业发展奖 (K01) 中提出了推动 SLE 疼痛体验的相关因素。 Falasinnu 将使用计算方法来增进对慢性病临床管理的理解在目标 1 中，Falasinnu 博士将开发一种计算慢性疼痛表型。使用从 EHR 中提取的诊断代码、疼痛评分、叙述性临床记录和药物的算法然后，她将使用该算法来估计两个大型医疗保健系统（n~2,400）的慢性疼痛患病率。在基于人群的登记中（n~76,000），在目标 2 中，Falasinnu 博士将全面分析表型。使用约 500 名就诊的 SLE 患者的现有登记，研究慢性疼痛的生物心理社会相关性在整个获奖过程中，Falasinnu 博士将继续她作为一名多学科疼痛中心的博士培训。流行病学家和生物统计学家开发生物医学信息学新技能，以进行有影响力的疼痛这些技能将包括使用电子病历和登记数据、机器学习和自然。通过课程作业、临床、语言处理、疼痛科学、资助写作和科学交流。 Falasinnu 博士将在疼痛医学诊所观察、指导以及外部会议和研讨会获得申请第一个 R01 所需的技能，并从事终身教授首席研究员的职业生涯。