Biopsychosocial Influence on Shoulder Pain

生物心理社会对肩痛的影响

基本信息

批准号：
10734103
负责人：
STEVEN Z GEORGE
金额：
$ 59.88万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-15 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10734103
关键词：
Address Adult Anatomy Anesthesia procedures Area Biochemical Biochemical Markers Biological Biological Factors Biological Markers Caring Characteristics Chronic Data Decision Making Degenerative polyarthritis Development Effectiveness Goals Health Healthcare Systems Hip region structure Individual Inflammatory International Classification of Diseases Intervention Knee Knowledge Literature Measures Mission Modeling National Institute of Arthritis, and Musculoskeletal, and Skin Diseases Observational Study Operative Surgical Procedures Orthopedic Surgery Pain Research Pain management Patient Care Patients Perioperative Phenotype Physical Function Population Postoperative Pain Postoperative Period Predictive Factor Predisposition Prospective, cohort study Proxy Psychological Factors Public Health Quality of life Replacement Arthroplasty Reporting Research Respondent Risk Risk Factors Risk Marker Rotator Cuff Shoulder Shoulder Pain Societies Strategic Planning Surveys Testing Time United States Work biopsychosocial chronic pain chronic pain management chronic painful condition cytokine economic impact effectiveness testing efficacy trial experience health care service utilization high risk improved individualized medicine novel opioid use pain chronification patient population precision medicine preclinical efficacy prevent primary outcome prognostic psychologic psychological distress public health priorities repaired risk stratification social factors social health determinants standard of care success treatment strategy

项目摘要

Abstract Treatment tailored to specific patient characteristics (i.e. precision medicine) has the potential to offer more effective options for post-operative pain management. Chronic pain conditions are a heavy burden to society due their economic impact and individual suffering they cause; and developing precision medicine approaches are a high priority for the Federal Pain Research Strategy. Accordingly, in this proposal, we will initiate a precision medicine approach for total shoulder arthroplasty by identifying a risk phenotype that is predictive of chronic post-surgical pain. Biologic, psychologic, and social factors (alone and in combination) will be considered as candidates for the risk phenotype. Additionally, changes in biochemical biomarkers and psychologic factors will be considered as post-operative time-varying factors to enhance predictive accuracy of the risk phenotype. This proposal will support a prospective cohort study of 461 individuals undergoing primary total shoulder arthroplasty (anatomic or reverse) at Duke Health. The primary outcome is chronic post- surgical pain 12-months after total shoulder arthroplasty. Risk phenotype measures will be collected pre- operatively and time-varying factors will be collected pre-operatively and post-operatively. We will investigate novel combinations of biologic, psychologic, and social factors to determine a chronic post-surgical pain risk phenotype for total shoulder arthroplasty. Additionally, time-varying factors will be tested for improving predictive accuracy of the risk phenotype. This proposal will advance the pain research field by addressing important knowledge gaps in chronic post-surgical pain development for adults with osteoarthritis that are undergoing a surgical procedure that is a) rapidly increasing in volume and b) has a high risk of post-operative pain. Successful completion of the study has the potential to alter standard of care for surgical selection and provide new avenues of precision medicine for post-operative pain management. Specifically, completion of this study may allow for risk stratification approaches that improve surgical decision making to be implemented in health care systems and/or identify novel treatment targets that could be tested for effectiveness in preventing chronic post-surgical pain.

抽象的根据特定患者特征量身定制的治疗（即精准医疗）有可能提供更多术后疼痛管理的有效选择。慢性疼痛是社会的沉重负担由于它们造成的经济影响和个人痛苦；并开发精准医学方法是联邦疼痛研究战略的高度优先事项。因此，在本提案中，我们将发起一项通过识别可预测的风险表型来进行全肩关节置换术的精准医学方法慢性术后疼痛。生物、心理和社会因素（单独或组合）将被视为风险表型的候选者。此外，生化生物标志物的变化和心理因素将被视为术后时变因素，以提高预测准确性的风险表型。该提案将支持一项对 461 名个体进行的前瞻性队列研究杜克健康中心进行初次全肩关节置换术（解剖型或反向型）。主要结果是慢性后全肩关节置换术后 12 个月的手术疼痛。将预先收集风险表型测量值将在术前和术后收集手术和随时间变化的因素。我们将调查生物、心理和社会因素的新颖组合来确定慢性术后疼痛风险全肩关节置换术的表型。此外，还将测试随时间变化的因素以改善风险表型的预测准确性。该提案将通过解决以下问题来推动疼痛研究领域的发展：成人骨关节炎患者在慢性术后疼痛发展方面存在重要的知识差距接受的外科手术 a) 体积迅速增加，b) 术后风险很高疼痛。该研究的成功完成有可能改变手术选择和治疗的护理标准为术后疼痛管理提供精准医疗的新途径。具体来说，完成这项研究可能允许采用风险分层方法来改善手术决策医疗保健系统和/或确定新的治疗目标，可以测试其有效性预防慢性术后疼痛。