Psychosocial distress, inflammatory reactivity and central sensitization in the pathway to HIV-related pain: characterizing the associations and developing a pragmatic, coping-focused intervention.

HIV 相关疼痛途径中的心理社会困扰、炎症反应性和中枢敏化：描述相关性并制定务实、以应对为重点的干预措施。

• 批准号: 10251422
• 负责人: Victoria Joy Madden
• 金额: $ 5.4万
• 依托单位: UNIVERSITY OF CAPE TOWN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-27 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10251422
• 关键词: Address; Affect; Anti-Retroviral Agents; Award; Caring; Cognitive Therapy; Cohort Studies; Communities; Complex; Country; Data; Development; Development Plans; Distal; Distress; Elements; Fibromyalgia; Future; HIV; Immune; Immune system; Immunology; Inflammation; Inflammatory; Inflammatory Response Pathway; Influentials; Innate Immune Response; Interdisciplinary Study; Interleukin-6; Intervention; Knowledge; Low Back Pain; Measures; Mediating; Mediation; Mentors; Mentorship; Methodology; Michigan; Modeling; Modernization; Nature; Neuraxis; Neuroimmune; Pain; Pain management; Participant; Pathology; Pathway interactions; Peripheral; Peripheral Nervous System Diseases; Persistent pain; Pharmacotherapy; Phase; Polyneuropathy; Prevalence; Problem Solving; Procedures; Process; Psyche structure; Psychology; Psychosocial Influences; Public Health; Reporting; Research; Research Personnel; Research Project Grants; Resources; Scientist; Secondary Hyperalgesias; Secure; Sensory; Site; South Africa; South African; Testing; Time; Training; Universities; Viral; Vision; Work; base; career; career development; central sensitization; chronic painful condition; community based participatory research; comparison group; coping; cytokine; experience; follow-up; hands on research; health care service; improved; individualized medicine; inflammatory pain; lecturer; pain outcome; pain relief; pilot trial; programs; psychologic; psychosocial; research clinical testing; response; skills; social; therapy development

Project Summary Candidate Dr Madden is a senior lecturer at the University of Cape Town who is committed to a research career in South Africa, with the career vision of leading interdisciplinary research to understand pain mecha- nisms and develop scale-able, focused treatments that safely and effectively relieve pain in resource-limited settings. With 5 years of dedicated research time, she will be able to implement her systematic career devel- opment plan to (1) deepen her understanding of advanced methodology and expertise in research program management, (2) expand her knowledge of HIV, immunology and psychosocial influences on pain, and (3) gain valuable first-hand experience in conducting community-based research in South Africa. This will de- velop her as the first South African cross-disciplinary expert in the interactions between psychology, immu- nology and pain in HIV. The career development plan is built around coordinated, cross-disciplinary training at the University of Cape Town, Harvard University and University of Michigan; hands-on research in South Africa, and close mentorship from a carefully selected team of highly experienced research scientists. Research Living with HIV is frequently accompanied by persistent pain and psychosocial distress (PSD). Most HIV-related pain is not explained by peripheral neuropathy, but resembles complex chronic pain condi- tions in which the immune system has been found to have an exaggerated response to provocation (inflam- matory reactivity). PSD is known to contribute to immune dysregulation and to pain. One pathway by which PSD may influence HIV-related pain is via inflammatory reactivity (IR) – but this has not been established. In this Research Project, Phase 1 (Specific Aim 1) aims to characterize the relationships between PSD, IR, central sensitization and persistent pain in HIV. It will use a cohort study with baseline measures from HIV+ people with/without persistent pain (2 groups), and longitudinal follow-up of a subsample of participants from each group over a 6-month period. Mediation analysis will clarify whether IR represents a pathway for the influence of PSD on HIV-related pain; group comparisons will contrast IR and central sensitization between those with and without persistent pain; generalized mixed effect models will examine fluctuations in PSD, IR and pain over time in each group. This will be the first characterization of the associations between psycho- social distress, inflammatory reactivity, central sensitization and HIV-related pain. Phase 2 (Specific Aim 2) aims to develop and determine the feasibility and acceptability of a pragmatic, scale-able, coping-focused intervention to decrease distress and pain in people with HIV in South Africa. The intervention will be devel- oped, for non-specialist delivery, during a culturally secure, stepwise formative process including community and receiver engagement. A small open pilot trial (n = 10) that incorporates iterative revision of intervention content and delivery will be used to test intervention feasibility and acceptability and to troubleshoot imple- mentation and assessment procedures to inform future, fully powered clinical testing.

项目摘要 候选人Madden博士是开普敦大学的高级讲师，他致力于研究 在南非的职业生涯，领导跨学科研究的职业愿景来了解疼痛机械 - nisms并开发出可扩展的，集中的治疗，可以安全有效地挽救资源有限的疼痛 设置。有5年的专门研究时间，她将能够实施自己的系统职业发展 - 期权计划（1）加深她对研究计划的先进方法论和专业知识的理解 管理，（2）扩大她对艾滋病毒，免疫学和心理社会影响疼痛的了解，以及（3） 在南非进行基于社区的研究方面获得有价值的第一手经验。这将使 她是心理学，侵害的第一位南非跨学科专家 艾滋病毒中的病学和疼痛。职业发展计划围绕着协调的跨学科培训 哈佛大学和密歇根大学开普敦大学；南方动手研究 非洲，以及一群经验丰富的研究科学家团队的心态。 HIV生活的研究经常伴随着持续的疼痛和社会心理困扰（PSD）。 周围神经病并不能解释大多数与HIV相关的疼痛，但类似于复杂的慢性疼痛。 发现免疫系统对挑衅有夸张的反应（inflam- 机理反应性）。已知PSD会导致免疫失调和疼痛。一条途径 PSD可能会通过炎症反应性（IR）影响与HIV相关的疼痛 - 但尚未确定。在 该研究项目，第1阶段（特定目的1）旨在表征PSD，IR， 艾滋病毒中的中心灵敏度和持续性疼痛。它将使用来自HIV+的基线测量的队列研究 患有/没有持续疼痛的人（2组），以及参与者的子样本的纵向随访 每个小组在6个月内。调解分析将阐明IR是否代表 PSD对HIV相关疼痛的影响；组比较将对比IR和中心灵敏度 那些有和没有持续痛苦的人；广义混合效应模型将检查PSD的波动 和每组的疼痛。这将是心理之间关联的第一个表征 社会困扰，炎症反应性，中心敏感性和与HIV相关的疼痛。阶段2（特定目标2） 旨在发展和确定务实，可应对的务实的可行性和可接受性 干预以减轻南非艾滋病毒患者的痛苦和疼痛。干预将是开发的 在文化安全的逐步形成过程中，在包括社区（社区 和接收器参与。一项小型开放试验试验（n = 10），结合了干预的迭代修订 内容和交付将用于测试干预的可行性和可接受性，并将其故障排除。 提及和评估程序，以告知未来，全功率的临床测试。