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

• 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
• 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

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1亿美国人的痛苦持续痛苦，每年耗资6350亿美元。在美国，那里 超过20万人患有SLE，一种慢性炎症性风湿病，具有多器官 不成比例地影响女性和种族少数群体的参与。患有慢性疾病，例如 SLE提供了多重挑战。疼痛是SLE中经常自我报告的症状，通常是第一个 疾病的症状。尽管有治疗的进展，但疼痛仍然是最突出的，最突出的患者 投诉。由于令人震惊 成瘾和死亡率的流行归因于阿片类药物滥用。估计有31-46％的SLE使用患者 处方OOID。在一项研究中，使用OIDS使用它们≥1年的70％的人，22％为 同时服用≥2种阿片类药物。 SLE患者的可能性几乎是一般的两倍 人口与阿片类药物相关的过量住院治疗。但是，减轻阿片类药物滥用的努力不能 在没有详细的理解和持续投资对基础研究的临床研究的情况下实现 产生和维持慢性疼痛的机制。表征SLE中慢性疼痛的燃烧是 至少有两个计数具有挑战性。首先，我们缺乏有关SLE慢性疼痛的患病率和灼伤的数据， 部分原因是没有可靠的方法来识别电子临床上明显疼痛的患者 健康记录（EHR）。其次，迫切需要了解生物心理社会机制和 相关的是驱动SLE中疼痛体验的相关性。在这个问题的职业发展奖（K01）中，Titilola博士 Falasinnu将使用计算方法来增加对临床管理的理解 使用EHR的SLE疼痛。在AIM 1中，Falasinnu博士将开发计算慢性疼痛表型 使用诊断代码，疼痛评分，叙事诊所注释和从EHRS提取的药物的算法 两个大型医疗保健系统（N〜2,400）。然后，她将使用算法来估计慢性疼痛流行 在基于人群的注册表中（N〜76,000）。在AIM 2中，Falasinnu博士将全面表型 使用约500例SLE患者参加的现有注册表的慢性疼痛的生物心理社会相关性 多学科疼痛中心。通过该奖项，Falasinnu博士将以她的博士培训为基础 流行病学家和生物统计学家发展生物医学信息的新技能，以进行有影响力的痛苦 医学研究。这些技能将包括使用EHR和注册表数据，机器学习和自然 语言处理，疼痛科学，赠款和科学交流。通过课程，临床 在疼痛医学诊所，精神训练以及外部会议和讲习班中观察，Falasinnu博士将 获得申请她的第一个R01所需的技能，并以终身制首席调查员的身份购买职业。