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.

慢性疼痛影响超过 1 亿美国成年人，估计每年造成 560-6350 亿美元的损失 对于非裔美国人 (AA) 来说，这一重大负担的研究相对较少。老年人患此病的风险增加。 患有多种疼痛状况，并且由于慢性疼痛的负面影响而寿命更长， 无论涉及何种解剖或诊断（例如背痛、偏头痛），都是导致残疾的主要原因 在世界范围内，对于所有疼痛状况是否存在共同机制的了解有限，无论疼痛状况如何。 诊断，导致治疗一种疼痛的医疗保健提供者的选择不足。 病症（例如关节疼痛）通常无法控制身体其他部位的症状（例如腹痛）， 患者经常从一位专家转诊至另一位专家，研究各种慢性病的共性。 未选择疼痛状况的社区队列中的重叠疼痛状况 (COPC) 可以提供 对慢性疼痛作为一种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，例如疼痛敏化（评估上行疼痛路径）和条件反射 疼痛调节（CPM）（评估下行疼痛调节）可能是所有潜在的共同机制 这些知识将促进针对所有类型的新型疼痛管理方法的开发。 尽管慢性疼痛给公共健康带来了巨大的负担，但无论涉及何种解剖或诊断， 对于老年 AA 成人中 COPC 的流行病学和演变以及 COPC 对健康的影响知之甚少。 我们建议老年 AA 的身体心理或社会功能、入住疗养院的风险和死亡率。 在即将对基于社区的老年 AA 队列进行彻底表征的研究访问中评估慢性疼痛 未选择任何疼痛投诉，杰克逊心脏研究 (JHS)（N~2540，三分之二≥65 岁）。 COPC 的流行病学，无论涉及的解剖或诊断如何，COPC 的演变 随着时间的推移，疼痛处理、健康生活方式因素和心理社会因素的神经生理学改变 我们建议 COPC 的危险因素以及 COPC 的后果和老年人疼痛处理的改变。 获得疼痛敏化和 CPM 的客观定量感觉测试 (QST) 测量，这些测量是 QST 评估的神经生理学改变是否与实验环境中的疼痛严重程度相关。 是所有形式的慢性疼痛以及身体和心理社会不良的常见潜在危险因素 未选择疼痛的社区老年 AA 队列的功能、住院治疗和死亡率 我们将收集有关多种慢性疼痛、QST、健康生活方式因素的数据。 身体和心理社会功能，以及在下一次计划的研究访问期间入住疗养院，以及 两次后续评估以获得纵向数据，并利用正在进行的 JHS 死亡率监测。 我们的工作将解决一些知识差距，所获得的见解最终可能会促进新的预防和 缓解慢性疼痛及其后果的治疗方法，无论潜在的诊断如何。