Severe Pain During Wound Care Procedures: Model and Mechanisms

伤口护理过程中的剧烈疼痛：模型和机制

• 批准号: 9070786
• 负责人: SUE E GARDNER
• 金额: $ 46.7万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9070786
• 关键词: Absence of pain sensation; Address; Adverse effects; Analgesics; Area; Basic Science; Biological; Biological Factors; Caring; Characteristics; Clinical Investigator; Clinical Research; Development; Diagnostic; Dose; Economic Burden; Failure; Fatigue; Funding Opportunities; Future; Genomics; Healed; Health; High Prevalence; Human; Impaired wound healing; Individual; Infection; Infection prevention; Inflammatory; Inpatients; Intake; Knowledge; Lead; Liquid substance; Logistic Regressions; Measures; Mission; Modeling; Nociception; Nociceptors; Numeric Rating Scale; Nurses; Opioid; Opioid Analgesics; Outcome; Oxygen; Pain; Pain Research; Pain intensity; Pain management; Patients; Pharmaceutical Preparations; Pneumonia; Prevention; Preventive; Procedures; Public Health; Receiver Operating Characteristics; Recommendation; Research; Research Personnel; Risk; Role; Sampling; Science; Sterile coverings; Stress; Symptoms; Technology; Work; base; chronic wound; cost; cytokine; effective intervention; experience; healing; microbial community; novel; open wound; opioid use; pain symptom; predictive modeling; prevent; sedative; symptom cluster; tool; wound

 DESCRIPTION (provided by applicant): Wound care procedures, such as dressing changes, cause moderate to severe pain in 74% of patients, nearly half (36%) of whom experience severe pain (rated as 8 to 10 on a 10-point numeric rating scale). Severe pain causes substantial stress for both patient and nurse. Unfortunately, the high prevalence of severe pain during WCPs is under-recognized and under-studied. To date, mainstay recommendations to prevent pain during WCPs have focused on either administration of preventive and procedural analgesia or use of expensive, non-adherent dressings. However, it is unclear which patients to target for analgesia or expensive dressings, leading to their inappropriate over or under use. Analgesics are given to only 23% of patients undergoing WCPs and dressings that may decrease pain are given to even fewer. The ability to predict which patients are likely to have severe pain during WCPs is critically needed so that they can be targeted for preventive pain control strategies, including use of opioid analgesics and special dressings. Aim 1 of this study is to develop and evaluate a model to predict severe pain during WCPs. Although opioids are often given for highly painful conditions, they may not be an optimal or adequate strategy for controlling pain in open wounds because they impair wound healing and could lead to wound chronicity. The arsenal of alternatives to opioids is extremely limited because the biological mechanisms that contribute to nociceptive sensitivity and high pain during WCPs are unknown. Knowledge of these mechanisms would direct the development of new, effective interventions. Aim 2 is to identify these mechanisms. We have assembled an exceptional multi-disciplinary team of investigators to execute the aims of this proposal. These include investigators with expertise in: clinical research of chronic wounds (PI: Gardner), clinical (Investigator: Rakel) and basic science (Consultant: Brennan) research of pain, genomic technologies to measure wound bioburden (Investigator: Grice), and statistical analyses, including receiver operating curves (Statistician: Hillis). To achieve the aims of the study, a comprehensive set of wound, patient, and biological factors will be measured concurrently with pain during a dressing change among a sample of 450 inpatients with open wounds. A predictive model will be developed and biological mechanisms will be examined using logistic regression. The model will be evaluated using receiver operator characteristic curves. The proposed study has the potential to make significant contributions because clinicians will be able to target those patients requiring preventive pain control, thereby eliminating the spiraling impact of painful procedures on nociceptor sensitization. In addition, the findings will provide foundational evidence for the development of needed, novel pain control strategies. The positive impact will be to optimize wound care, minimize adverse effects of pain and treatment, and reduce the costs associated with wound care.

 描述（由适用提供）：伤口护理程序，例如敷料变化，导致74％的患者中度至重度疼痛，其中近一半（36％）经历了严重的疼痛（在10点数字评级量表上估计为8至10）。严重的疼痛会给患者和护士带来巨大的压力。不幸的是，WCP期间严重疼痛的高流行率不足和研究不足。迄今为止，在WCP期间预防疼痛的主要建议专注于预防和程序镇痛或使用昂贵的，非贴心的敷料。但是，目前尚不清楚哪个患者靶向镇痛或昂贵的敷料，从而导致他们在使用或正在使用的情况下。只有23％接受WCP的患者的镇痛药和可能减轻疼痛的患者的镇痛药被给予更少的疼痛。至关重要的是，在WCP中预测哪些患者可能会遭受严重疼痛的能力，因此可以将它们作为预防性疼痛控制策略的目标，包括使用阿片类镇痛药和特殊敷料。本研究的目标1是开发和评估模型，以预测WCP期间的严重疼痛。尽管通常针对高度疼痛的疾病给予阿片类药物，但它们可能不是控制敞开伤口的最佳或适当策略，因为它们会损害伤口愈合并可能导致慢性病。阿片类药物替代品的武器库非常有限，因为在WCP期间有助于伤害感受敏感性和高疼痛的生物学机制是未知的。了解这些机制将指导新的有效干预措施的发展。目标2是确定这些机制。我们已经组建了一个杰出的跨学科研究团队，以执行该提案的目标。其中包括具有专业知识的研究人员：慢性逻辑的临床研究（PI：Gardner），临床（研究者：Rakel）和 基础科学（顾问：Brennan）疼痛的研究，测量伤口生物负责人的基因组技术（研究者：GRICE）和统计分析，包括接收器操作曲线（统计学家：Hillis）。为了达到研究的目的，将在450名患有开放式伤口的住院患者样本中同时测量一组全面的伤口，患者和生物因素。将开发一个预测模型，并将使用逻辑回归研究生物学机制。该模型将使用接收器操作员特征曲线进行评估。拟议的研究有可能做出重大贡献，因为临床医生将能够针对那些需要预防性疼痛的患者，从而消除了疼痛手术对伤害感受器敏感性的螺旋影响。此外，这些发现将为开发所需的新型疼痛控制策略的发展提供基本证据。积极的影响是优化伤口护理，最大程度地减少疼痛和治疗的不良影响，并降低与伤口护理相关的成本。