Optimizing the value of pain management in knee OA patients with comorbidities

优化疼痛管理对患有合并症的膝骨关节炎患者的价值

• 批准号: 9975101
• 负责人: Elena Losina
• 金额: $ 72.93万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9975101
• 关键词: Address; Affect; American; Analgesics; Antidepressive Agents; Behavioral; Caring; Clinical; Clinical Management; Computer Simulation; Coupled; Decision Analysis; Degenerative polyarthritis; Economics; Exercise; Frequencies; Funding; Health; Health Expenditures; Infrastructure; Investments; Knee Osteoarthritis; Knowledge; Lead; Mental Depression; Mental Health; Mental disorders; Methodology; Methods; Modeling; Morbid Obesity; Nervous system structure; Neuropathy; Nociception; Obesity; Operative Surgical Procedures; Pain; Pain management; Patients; Persons; Pharmaceutical Preparations; Pharmacology; Pharmacotherapy; Phenotype; Physical activity; Population; Prevalence; Quality of life; Quality-Adjusted Life Years; Regimen; Research; Risk; Symptoms; Syndrome; Therapeutic; Translating; Weight maintenance regimen; bariatric surgery; base; behavior change; clinical practice; comorbidity; cost; cost effective; cost effectiveness; diagnostic accuracy; disability; economic impact; economic value; exercise program; improved; improved outcome; innovation; insight; knee pain; knee replacement arthroplasty; large datasets; models and simulation; multidisciplinary; non-opioid analgesic; opioid epidemic; opioid use; osteoarthritis pain; pain reduction; physical inactivity; programs; routine care; treatment strategy

The broad objective guiding our research is to conduct analyses that will provide critical insights to clinicians and decision makers to optimize knee OA pain management while reducing opioid use in persons with OA and major comorbidities including mental health disorders and morbid obesity. Symptomatic knee osteoarthritis (OA) affects over 14 million Americans and accounts for $27 billion/year in healthcare expenditures. Traditional views of knee OA pain as nociceptive have been challenged by evolving evidence that nervous system alterations often result in sensitization and neuropathic-like symptoms. Many OA patients have comorbidities including depression, which leads to worse knee pain and complicates pain management, especially regarding opioid use. Medications are only modestly efficacious, in part because they are not tailored to pain mechanisms. Obesity, especially morbid obesity, further complicates both pharmacologic and surgical OA pain management. The diversity of pain mechanisms and frequency of comorbidities have begun to reframe knee OA as a syndrome comprised of multiple phenotypes, wherein a single treatment strategy does not fit all. The challenges in OA pain management posed by multiple pain phenotypes and comorbidities, coupled with the threat of the opioid epidemic, are further exacerbated by the gap between `what we know' and `what we do.' While the efficacy of pain phenotype-based pharmacotherapy, weight management and exercise have been established in RCTs these approaches have not translated to routine care. PA is essential to managing OA pain, yet most OA patients are inactive. Strong evidence suggests that exercise and physical activity (PA) are as effective as analgesic medications, but implementation of exercise programs is hindered by lack of infrastructure and funds. Comorbidities augment the risk of physical inactivity, despite strong evidence that PA is efficacious in OA patients with comorbidities. Evidence of efficacy is not sufficient to facilitate the implementation of these programs into clinical practice. Implementation requires investment; and knowledge of the cost-effectiveness and budgetary impact of these programs will help to translate research findings into day-to-day clinical management. Decision analysis is an important methodology that helps to evaluate the value of programs that have been shown to be efficacious. We propose to use a validated computer simulation model of knee OA (OAPol) to narrow the gap between evidence and practice by assessing the value of three major therapeutic strategies in managing pain in knee OA patients with comorbidities: 1) tailored pain management according to pain phenotypes to optimize pharmacologic regimens; 2) weight management in morbidly obese persons to improve outcomes of OA-focused treatments; and 3) PA programs as non-pharmacologic pain reduction regimens.

广泛的目标指导我们的研究是进行分析，该分析将为临床医生提供关键的见解 和决策者，以优化膝盖OA疼痛管理，同时减少OA和患者的阿片类药物使用 主要合并症，包括心理健康障碍和病态肥胖。 有症状的膝盖骨关节炎（OA）影响超过1400万美国人，占270亿美元/年 医疗支出。膝关节疼痛的传统观点是伤害感受的，通过不断发展而挑战 神经系统改变通常会导致敏化和神经性症状的证据。许多 OA患者的合并症在内 管理，特别是关于阿片类药物的使用。药物仅是适度有效的，部分是因为它们 不是根据疼痛机制量身定制的。肥胖，尤其是病态肥胖，使两者都复杂化 药理和手术OA疼痛管理。疼痛机制的多样性和频率 合并症已经开始将膝盖OA重新构成由多种表型组成的综合征，其中 单个治疗策略不合适。 多种疼痛表型和合并症带来的OA疼痛管理中的挑战，再加上 阿片类流行病的威胁因“我们所知道的”和“我们做什么”之间的差距进一步加剧。 虽然基于疼痛表型的药物治疗的功效，体重管理和运动的功效 在RCT中建立的这些方法尚未转化为常规护理。 PA对于管理OA疼痛至关重要， 然而，大多数OA患者都是不活跃的。有力的证据表明，运动和体育锻炼（PA）是 作为镇痛药有效，但是由于缺乏 基础设施和资金。合并症增加了身体不活动的风险，尽管有强烈的证据表明PA 在合并症患者的OA患者中有效。功效的证据不足以促进 将这些程序实施到临床实践中。实施需要投资；和知识 这些计划的成本效益和预算影响将有助于将研究发现转化为 日常临床管理。 决策分析是一种重要的方法论，可以帮助评估已经存在的计划的价值 被证明是有效的。我们建议使用经过验证的膝盖OA（oapol）的计算机模拟模型 通过评估三种主要治疗策略的价值来缩小证据和实践之间的差距 控制合并症的膝盖OA患者的疼痛：1）根据疼痛量身定制疼痛管理 优化药理方案的表型； 2）病态肥胖者的体重管理以改善 以OA为中心的治疗结果； 3）PA程序作为非药物减轻疼痛方案。