Pain in community-based older African American Adults: The Jackson Heart Study

社区老年非裔美国成年人的疼痛：杰克逊心脏研究

• 批准号: 10642771
• 负责人: Emelia J. Benjamin
• 金额: $ 62.87万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10642771
• 关键词: Abdominal Pain; Address; Admission activity; Adult; Affect; African American; African American population; American; American Heart Association; Anatomy; Arthralgia; Back Pain; Body part; Cessation of life; Chronic; Cohort Studies; Communities; Data; Degenerative polyarthritis; Development; Diagnosis; Disease; Distress; Elderly; Epidemiologist; Epidemiology; Evaluation; Evolution; Funding; Health Personnel; High Prevalence; Incidence; Individual; Institutionalization; Interdisciplinary Study; International; Jackson Heart Study; Joints; Knowledge; Life; Location; Low Prevalence; Maintenance; Measures; Migraine; Musculoskeletal; Neurologic; Nursing Homes; Outcome; Pain; Pain Measurement; Pain management; Pathway interactions; Patient-Focused Outcomes; Patients; Physical Function; Population; Prevalence; Preventive; Psychologist; Psychosocial Factor; Public Health; Risk; Risk Factors; Sampling; Sensory; Severities; Social Network; Social support; Specialist; Spirituality; Stress; System; Testing; Therapeutic; Time; Visit; Work; body system; care coordination; chronic pain; chronic painful condition; cohort; conditioned pain modulation; coping; cost estimate; disability; follow up assessment; follow-up; gastrointestinal; healthy lifestyle; human old age (65+); innovation; insight; lifestyle factors; mortality; mortality risk; multidisciplinary; negative affect; neurophysiology; novel; optimism; pain processing; psychosocial; racial health disparity; resilience; rheumatologist; social health determinants; social influence; stressor; surveillance study; years lived with disability

Chronic pain affects over 100 million American adults, with an estimated cost of $560-635 billion annually, yet this major burden is relatively understudied in African Americans (AAs). Older adults are at increased risk of having multiple painful conditions and are living longer with the negative impacts of chronic pain. Chronic pain, regardless of anatomy or diagnosis involved (e.g., back pain, migraine), is the leading cause of disability worldwide. Limited insights into whether common mechanisms underlie all pain conditions, regardless of diagnosis, has contributed to inadequate pain management options. Health care providers who treat one pain condition (e.g., joint pain) typically do not manage symptoms in other parts of the body (e.g., abdominal pain), and patients are often referred from one specialist to another. Studying commonalities of various chronic overlapping pain conditions (COPC) in community-based cohorts unselected for pain conditions can provide novel insights into causes and consequences of chronic pain as a disease itself. For example, neurophysiologic alterations in pain processing such as pain sensitization (assessing ascending pain pathways) and conditioned pain modulation (CPM) (assessing descending pain modulation) may be common mechanisms underlying all chronic pain. Such knowledge would spur development of novel pain management approaches for all types of pain regardless of anatomy or diagnosis involved. Despite the substantial public health burden of chronic pain, little is known about the epidemiology and evolution of COPC in older AA adults, nor of the impact of COPC on physical or psychosocial function, risk of nursing home admission, and mortality in older AAs. We propose to evaluate chronic pain in the upcoming study visit of a thoroughly-characterized community-based older AA cohort unselected for any pain complaints, the Jackson Heart Study (JHS) (N~2540, two-thirds ≥age 65). We aim to understand the epidemiology of COPC, regardless of anatomy or diagnosis involved, the evolution of COPC over time, neurophysiologic alterations in pain processing, healthy lifestyle factors and psychosocial factors as risk factors for COPC, and consequences of COPC and altered pain processing in older adults. We propose acquiring objective quantitative sensory testing (QST) measures of pain sensitization and CPM, which are associated with pain severity in experimental settings. Whether QST-assessed neurophysiologic alterations may be common underlying risk factors for all forms of chronic pain, and for poor physical and psychosocial functioning, institutionalization, and mortality in a community-based cohort of older AAs unselected for pain is unknown. We will collect data regarding a multitude of chronic pain conditions, QST, healthy lifestyle factors, physical and psychosocial function, and nursing home admissions during the next planned study visit, as well as two follow-up assessments to obtain longitudinal data, and leverage the ongoing JHS surveillance of mortality. Our work will address several knowledge gaps, and insights gained may ultimately facilitate new preventive and therapeutic approaches to relieving chronic pain and its consequences, regardless of underlying diagnosis.

慢性疼痛会影响超过1亿美国成年人，估计每年成本为560-6.35亿美元，但 在非洲裔美国人（AAS）中相对理解了这个主要的伯恩。老年人的风险增加 患有多种疼痛状况，寿命更长，慢性疼痛的负面影响。慢性疼痛， 不管涉及的解剖结构或诊断性（例如，背痛，偏头痛）都是残疾的主要原因 全世界。对所有疼痛条件是否构成的共同机制是否有限的见解，无论如何 诊断，导致疼痛管理方案不足。治疗一种痛苦的医疗保健提供者 病情（例如，关节疼痛）通常不会在身体其他部位（例如腹痛）中处理症状， 患者经常从一位专家转介给另一个专家。研究各种慢性的共同点 在未针对疼痛状况的基于社区的同类群体中重叠的疼痛状况（COPC）可以提供 对慢性疼痛作为疾病本身的原因和后果的新见解。例如，神经生理学 疼痛处理的改变，例如疼痛敏感性（评估上升疼痛途径）并条件 疼痛调节（CPM）（评估降临疼痛调节）可能是所有的常见机制 慢性疼痛。这样的知识将刺激各种类型的新型疼痛管理方法的发展 疼痛不管解剖学或诊断涉及什么。尽管慢性疼痛的公共卫生烧毁了，但 关于年龄较大的AA成年人的流行病学和COPC的进化知之甚少，也不对COPC的影响对 身体或社会心理功能，护理家庭入学的风险以及年龄较大的AAS死亡率。我们建议 在即将到来的研究访问中评估慢性疼痛 杰克逊心脏研究（JHS）（n〜2540，三分之二≥65）未选择任何疼痛抱怨。我们的目标 了解COPC的COPC的流行病学，COPC的演变 随着时间的流逝，疼痛处理中的神经生理学改变，健康的生活方式因素和社会心理因素 COPC的危险因素以及COPC的后果和老年人的疼痛处理改变。我们建议 疼痛敏感性和CPM的准确定量感觉测试（QST）测量 与实验环境中的疼痛严重程度相关。 QST评估的神经生理学改变是否可能 是所有形式的慢性疼痛以及身体和社会心理差的常见危险因素 在未针对痛苦的较老的AA的基于社区的同类中，功能，制度化和死亡率是 未知。我们将收集有关多种慢性疼痛状况，QST，健康生活方式因素的数据， 身体和社会心理功能，以及在下一次计划学习访问期间的护理家庭入学以及 两项随访评估以获得纵向数据，并利用正在进行的JHS死亡率监视。 我们的工作将解决一些知识差距，而获得的见解最终可能有助于新的预防性和 无论诊断如何，都可以缓解慢性疼痛及其后果的治疗方法。