Optimizing pain-related outcomes following orthopedic trauma: testing novel risk factors and determining the feasibility of a new pain psychology intervention

优化骨科创伤后疼痛相关的结果：测试新的危险因素并确定新的疼痛心理学干预的可行性

• 批准号: 10683928
• 负责人: Rachel V. Aaron
• 金额: $ 18.15万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683928
• 关键词: Acute; Address; Affective; Aftercare; Amputation; Analgesics; Anxiety; Awareness; Benchmarking; Clinical Research; Clinical Trials; Data; Dedications; Development; Distress; Doctor of Philosophy; Eligibility Determination; Emotional; Emotions; Environment; Event; Faculty; Foundational Skills; Functional disorder; Funding; Goals; Grant; Individual; Injury; Intervention; K-Series Research Career Programs; Laboratories; Lead; Learning; Life; Literature; Measures; Medical; Mental Depression; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentorship; Moods; Multiple Fractures; Nociceptors; Operative Surgical Procedures; Opioid; Orthopedics; Outcome; Pain; Patients; Persistent pain; Persons; Population; Post-Traumatic Stress Disorders; Process; Prospective cohort; Psychologist; Psychology; Recovery; Rehabilitation therapy; Reporting; Research; Risk; Risk Factors; Science; Sensory; Severities; Spinal; Surveys; Survivors; Symptoms; Testing; Training; Trauma; Trauma patient; United States; Universities; Vertebral column; Work; arm; career; career development; central sensitization; chronic pain; chronic pain management; clinically significant; common symptom; compliance behavior; design; disability; disabling symptom; efficacy evaluation; emotion regulation; experience; feasibility testing; follow-up; improved; improved outcome; novel; opioid use; pain symptom; participant enrollment; post-trauma; prescription opioid; programs; psychologic; psychological distress; recruit; research and development; response; satisfaction; severe injury; success; theories; therapy development; trauma exposure

PROJECT SUMMARY The long-term goal of this K23 Career Development Award is to prepare the PI (Rachel Aaron, PhD) for an independent research career that aims to promote adaptive recovery for individuals who survive orthopedic trauma. Orthopedic trauma, resulting in severe injuries such as multiple fractures or amputation, occurs in around 3 million people annually in the United States; about half of survivors experience persistent pain and psychological distress in the year following injury, and most report substantial disability 7 years post trauma. There is an urgent need to identify factors that underlie pain and psychological distress following orthopedic trauma and to develop targeted psychological interventions to treat these potentially disabling symptoms. The broader literature suggests that difficulties with emotion regulation (i.e., identifying one's emotions and engaging in strategies to up- or down-regulate them) and central sensitization (i.e., alterations in the endogenous modulation of pain) lead to poor pain-related outcomes. Using a theory-driven assessment of emotion regulation, and gold-standard, laboratory-based assessment of central sensitization (quantitative sensory testing [QST]), Study 1 will examine emotion regulation difficulties and central sensitization at 6 weeks post trauma as predictors of persistent pain, distress, and opioid use 6 months post trauma. Study 2 will test the feasibility of assessing and delivering Emotional Awareness and Expression Therapy (EAET) to people who endorse persistent pain (i.e., clinically significant pain, present most days for the past 3 months) at 6 months post trauma. EAET is a novel chronic pain psychology intervention that treats pain and distress by targeting trauma-related emotion regulation process. Trauma exposure is ubiquitous among orthopedic trauma survivors; thus, EAET may be ideally suited for those with persistent pain post trauma. However, the feasibility of delivering EAET is unclear due to established barriers engaging this population in mental health treatment. Proposed research and career development activities will take place at Johns Hopkins University (JHU), a renowned research environment. JHU is dedicated to the success of its junior faculty and provides unique access to orthopedic trauma patients. The PI has formed a strong team of content experts in central sensitization (including QST), psychological intervention (including EAET), and orthopedic trauma. Immersed in JHU's rich training environment, the PI will achieve the following career goals through dedicated mentorship, didactic experiences, and professional development opportunities: (1) develop expertise in the assessment of central sensitization, including QST; (2) gain foundational skills for intervention development, implementation, and analysis; and (3) learn to lead impactful orthopedic trauma clinical research. The completion of this K23 proposal will provide the necessary training and preliminary data for the PI to obtain independent grant funding and systematically pursue a line of research to improve outcomes for survivors of orthopedic trauma.

项目概要 K23 职业发展奖的长期目标是让 PI（Rachel Aaron 博士）为 一项独立的研究事业，旨在促进骨科幸存者的适应性康复 创伤。骨科创伤，导致严重伤害，如多处骨折或截肢，发生在 美国每年约有 300 万人；大约一半的幸存者经历持续的疼痛 受伤后一年内会出现心理困扰，大多数人在创伤后 7 年内报告严重残疾。 迫切需要确定骨科术后疼痛和心理困扰的因素 创伤并制定有针对性的心理干预措施来治疗这些潜在的致残症状。 更广泛的文献表明，情绪调节（即识别自己的情绪）存在困难 并采取上调或下调它们的策略）和中枢敏化（即改变 疼痛的内源性调节）会导致与疼痛相关的不良结果。使用理论驱动的评估 情绪调节，以及金标准、基于实验室的中枢敏化评估（定量 感觉测试 [QST]），研究 1 将检查 6 周时的情绪调节困难和中枢敏化 创伤后作为创伤后 6 个月持续性疼痛、痛苦和阿片类药物使用的预测因子。研究2将测试 评估并向人们提供情绪意识和表达疗法（EAET）的可行性 6 点认可持续性疼痛（即临床上显着的疼痛，过去 3 个月的大部分时间都出现） 创伤后几个月。 EAET 是一种新型的慢性疼痛心理学干预措施，通过以下方式治疗疼痛和困扰 针对创伤相关的情绪调节过程。创伤暴露在骨科创伤中普遍存在 幸存者；因此，EAET 可能非常适合创伤后持续疼痛的患者。不过，可行性 由于该人群接受心理健康治疗存在既定障碍，因此提供 EAET 的情况尚不清楚。 拟议的研究和职业发展活动将在约翰·霍普金斯大学进行 （JHU），著名的研究环境。 JHU 致力于其初级教师的成功，并提供 接触骨科创伤患者的独特途径。 PI在中央组建了强大的内容专家团队 致敏（包括 QST）、心理干预（包括 EAET）和骨科创伤。沉浸式 在JHU丰富的培训环境中，PI将通过专注的指导实现以下职业目标， 教学经验和专业发展机会：(1) 发展评估方面的专业知识 中枢敏化，包括 QST； (2) 获得干预开发、实施的基本技能， 和分析； (3) 学习领导有影响力的骨科创伤临床研究。 K23的完成 提案将为PI提供必要的培训和初步数据以获得独立资助 并系统地进行一系列研究，以改善骨科创伤幸存者的预后。