Transition from Acute to Chronic Pain After Thoracic Surgery

胸外科手术后从急性疼痛转变为慢性疼痛

• 批准号: 10222802
• 负责人: Chad M Brummett
• 金额: $ 232.6万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222802
• 关键词: Acute; Anxiety; Biological; Biological Markers; Blood specimen; Blue Cross; Blue Shield; Budgets; Cardiovascular system; Caring; Cellular Phone; Chest; Child; Chronic; Clinical; Clinical Trials; Complement; Data; Data Element; Development; Diagnostic; Dissemination and Implementation; Ensure; Esophagus; Excision; Faculty; Failure; Fatigue; Funding; Genomics; Goals; Health Status; Healthcare Systems; Hospitals; Incidence; Individual; Lead; Leadership; Longitudinal Studies; Low Back Pain; Lung; Measures; Michigan; National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institute of Diabetes and Digestive and Kidney Diseases; Online Systems; Operative Surgical Procedures; Opioid; Outcome; Pain; Pain Research; Participant; Pathway interactions; Patient Care; Patient Outcomes Assessments; Patient Recruitments; Patient Self-Report; Patients; Perioperative; Phenotype; Play; Population; Postoperative Pain; Postoperative Period; Prevention; Procedures; Prospective Studies; Proteomics; Provider; Repeat Surgery; Reporting; Research; Research Design; Resolution; Resources; Risk Factors; Role; Sample Size; Sampling; Science; Sensory; Site; Societies; Surgeon; Testing; Thoracic Surgical Procedures; Thoracotomy; United States National Institutes of Health; Universities; Work; base; biomarker selection; chronic pain; chronic pelvic pain; clinical center; clinical pain; cohort; design; experience; high risk; hip replacement arthroplasty; knee replacement arthroplasty; metabolomics; neuroimaging; novel; pain processing; pain symptom; population based; prescription opioid; prevent; programs; reconstruction; recruit; rheumatologist; risk variant; sample collection; success; web-enabled

PROJECT SUMMARY / ABSTRACT Chronic post-surgical pain (CPSP) is a major cause of new chronic pain, occurring between 10 - 40% after common surgical procedures. Thoracic surgery procedures have among the highest rates of chronic post- surgical pain (CPSP), with roughly 30 - 47% of patients developing new chronic pain within 6 months of surgery. While the high incidence of CPSP following thoracic surgery is well-described, the patient- and care- factors associated with the development of CPSP are still not clear. Some factors such as anxiety have been described; however, most cohorts lack the sample size to assess potentially important factors, including neuroimaging, quantitative sensory testing, and blood samples for genomics, metabolomics and proteomics. We believe that thoracic surgery is an ideal second surgical population to add to the Acute to Chronic Pain Signatures (A2CPS) program, complementing the first MCC population of knee arthroplasty, which has much lower rates of new CPSP but is a better cohort to identify risk factors for failure to resolve chronic pain. Our inter-disciplinary team from the proposed University of Michigan A2CP Multisite Clinical Center (MCC) has unparalleled expertise to examine the phenotypic and genotypic risk factors for the development of CPSP among patients undergoing thoracic surgery. Our co-PIs include an anesthesiologist, two surgeons, and a rheumatologist that have successfully collaborated in ongoing work, and partner within a statewide network of hospitals performing thoracotomy procedures, the Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) Quality Collaborative. Collaborative quality improvement programs including MSTCVS are funded by Blue Cross Blue Shield of Michigan to conduct participatory, provider-driven quality improvement initiatives, and our team has heavily leveraged these to study postoperative pain- and opioid-related outcomes and generate best practices. The implementation and dissemination of these best practices has dramatically reduced perioperative prescribing of opioids in the state of Michigan, and this strong partnership will enable us to recruit thoracotomy patients from a population-based sample across diverse healthcare systems. We will recruit 1800 patients from seven hospitals in Michigan undergoing surgery via a thoracic approach (lung resection, esophageal resection/reconstruction, and other general thoracic surgery). We will capture patient-reported health status alongside QST and functional neuroimaging at baseline and 6 months using a novel smart phone- and web-enabled application. At baseline and 6 months, biological samples will also be collected. From the 1800 participants recruited, we will identify 200 cases and 200 controls of CPSP at 6 months after surgery for repeated neuroimaging, quantitative sensory testing and blood sample collection. The successful completion of the proposed study would provide an unparalleled resource for the understanding the factors associated with CPSP and will allow for more efficient and personalized trials to prevent the development of chronic pain after thoracotomy and other thoracic surgeries.

项目概要/摘要 慢性术后疼痛 (CPSP) 是新发慢性疼痛的主要原因，发生于术后 10 - 40% 常见的外科手术。胸外科手术是慢性术后并发症发生率最高的手术之一。 手术疼痛 (CPSP)，大约 30 - 47% 的患者在手术后 6 个月内出现新的慢性疼痛 外科手术。虽然胸科手术后 CPSP 的高发病率已得到充分描述，但患者和护理人员 与 CPSP 发生相关的因素尚不清楚。焦虑等一些因素 描述；然而，大多数队列缺乏样本量来评估潜在的重要因素，包括 神经影像、定量感官测试以及基因组学、代谢组学和蛋白质组学的血液样本。 我们相信胸外科是补充急性至慢性疼痛的理想第二手术人群 Signatures (A2CPS) 计划，补充了膝关节置换术的第一批 MCC 人群，该人群有很多 新 CPSP 的发生率较低，但是识别未能解决慢性疼痛的风险因素的更好队列。我们的 来自拟建的密歇根大学 A2CP 多站点临床中心 (MCC) 的跨学科团队 无与伦比的专业知识来检查 CPSP 发展的表型和基因型风险因素 在接受胸外科手术的患者中。我们的联合 PI 包括一名麻醉师、两名外科医生和一名 风湿病专家在正在进行的工作中成功合作，并在全州网络内合作 进行开胸手术的医院、密歇根胸外科协会 心血管外科医生 (MSTCVS) 质量协作。协作质量改进计划 包括 MSTCVS 均由密歇根州 Blue Cross Blue Shield 资助，开展参与性、提供商驱动的活动 质量改进举措，我们的团队充分利用这些举措来研究术后疼痛和 阿片类药物相关的结果并产生最佳实践。这些最佳方案的实施和传播 密歇根州的这种做法大大减少了围术期阿片类药物的处方，这种强烈的 合作伙伴关系将使我们能够从不同人群的人群样本中招募开胸手术患者 医疗保健系统。我们将从密歇根州的七家医院招募 1800 名接受手术的患者 胸腔入路（肺切除、食管切除/重建和其他普通胸腔手术）。 我们将在基线和 6 时捕获患者报告的健康状况以及 QST 和功能神经影像。 使用新颖的智能手机和网络应用程序几个月。在基线和 6 个月时，生物 还将收集样本。从招募的 1800 名参与者中，我们将确定 200 个案例和 200 个 术后 6 个月进行 CPSP 对照，进行重复神经影像学、定量感觉测试和血液检查 样本采集。拟议研究的成功完成将为以下方面提供无与伦比的资源： 了解与 CPSP 相关的因素并将允许更有效和个性化的试验 防止开胸手术和其他胸部手术后出现慢性疼痛。