A Multisystem Resilience Approach in the Assessment of Postsurgical Pain Trajectories

评估术后疼痛轨迹的多系统弹性方法

• 批准号: 10736041
• 负责人: Emily J. Bartley
• 金额: $ 59.85万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-14 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736041
• 关键词: Address; Adult; Affect; Age; Arthritis; Behavioral; Biological; Characteristics; Chronic; Chronic disabling pain; Chronic low back pain; Consensus; Degenerative polyarthritis; Development; Dimensions; Elderly; Exhibits; Goals; Health; Hip region structure; Individual; Intervention; Investigation; Joints; Knee; Knowledge; Literature; Measures; Mental Depression; Modality; Modeling; Nature; Observational Study; Operative Surgical Procedures; Orthopedic Procedures; Orthopedic Surgery; Outcome; Pain; Patients; Pattern; Perioperative; Persistent pain; Persons; Phenotype; Physical Function; Population; Postoperative Pain; Postoperative Period; Precision Medicine Initiative; Prediction of Response to Therapy; Predictive Factor; Procedures; Process; Psychosocial Factor; Recovery; Refractory; Replacement Arthroplasty; Research; Resources; Risk Factors; Role; Sampling; Severities; Site; Social support; Sociology; Source; Stress; Symptoms; System; Techniques; Theoretical model; Time; United States; Work; chronic pain; chronic painful condition; cognitive function; decrease resilience; depressive symptoms; disability; experience; functional disability; global health; health care service utilization; hip replacement arthroplasty; improved; individual patient; innovation; insight; knee replacement arthroplasty; novel; opioid use; optimism; pain adaptation; pain catastrophizing; pain model; pain relief; patient subsets; postoperative recovery; precision medicine; promote resilience; prospective; protective effect; protective factors; psychologic; resilience; resilience factor; response; risk stratification; social; success; symptomatology; therapeutic development; tool; trait; treatment response

PROJECT SUMMARY/ABSTRACT Osteoarthritis affects approximately 30 million people in the United States and is the leading cause of pain and disability among older adults. Total joint arthroplasty (TJA) is among the most common elective surgery for patients with refractory knee and hip arthritis. Although a proportion of patients achieve benefits from TJA, up to 34% of patients develop chronic postsurgical pain (CPSP) following the procedure, with approximately 33% of patients experiencing high impact or bothersome pain. While risk factors underlying CPSP following TJA have been well documented, the mechanisms of resilience that predict treatment success are poorly characterized and not routinely assessed. Building on prior research, we propose a novel conceptual model of pain resilience that defines resilient functioning as a dynamic and multidimensional process that engages numerous systems, a concept referred to as multisystem pain resilience (MSPR). In our preliminary work, we have found that individuals with a greater degree of protective resources across multiple domains (i.e., psychological, social, health) exhibit more optimal psychological, physical, and pain-related functioning when compared to those with a lower resilient phenotype. Thus, investigating a broad range of adaptive factors may provide important predictive insights into the unique combination of resources that account for resilient response trajectories following TJA. In line with the Precision Medicine Initiative, the aims of this prospective observational study are to explore mechanisms associated with treatment response in patients undergoing knee and hip arthroplasty, and to characterize associations between MSPR phenotypic profiles with pain impact and physical function trajectories. To address this goal, 300 patients ages 18+ years undergoing knee and hip arthroplasty will undergo prospective assessments of MSPR factors and outcomes at baseline and at five postsurgical time points over a 9-month period. Patients will complete measures across the following MSPR domains comprised of modifiable factors associated with pain: 1) demographic, 2) health, 3) biological, 4) behavioral, 5) psychological, and 6) sociological. Collectively, these aims have the potential to advance understanding of phenotypic mechanisms underlying postsurgical pain impact and physical function trajectories and may be a step toward the development of therapeutic modalities aimed at promoting enhanced recovery and reducing overall pain burden in patients undergoing arthroplasty.

项目概要/摘要 骨关节炎影响着美国约 3000 万人，是导致疼痛和疼痛的主要原因。 老年人的残疾。全关节置换术（TJA）是最常见的择期手术之一 难治性膝关节炎和髋关节炎患者。尽管有一部分患者从 TJA 中获益，但高达 34% 的患者在手术后出现慢性术后疼痛 (CPSP)，其中约 33% 经历剧烈疼痛或令人烦恼的疼痛的患者。虽然 TJA 后 CPSP 的风险因素 已有充分记录，但预测治疗成功的恢复机制却很少被描述 并且不定期评估。基于先前的研究，我们提出了一种新的疼痛恢复概念模型 将弹性功能定义为涉及众多系统的动态多维过程， 一个称为多系统疼痛弹性（MSPR）的概念。在我们的前期工作中，我们发现 跨多个领域（即心理、社会、 与健康状况不佳的人相比，表现出更佳的心理、身体和疼痛相关功能 较低的弹性表型。因此，研究广泛的适应性因素可能会提供重要的信息 对独特的资源组合的预测性见解，可解释弹性响应轨迹 继TJA之后。根据精准医学计划，这项前瞻性观察研究的目的是 探索与接受膝关节和髋关节置换术的患者治疗反应相关的机制， 并描述 MSPR 表型特征与疼痛影响和身体功能之间的关联 轨迹。为了实现这一目标，300 名 18 岁以上接受膝关节和髋关节置换术的患者将接受 对基线和五个术后时间点的 MSPR 因素和结果进行前瞻性评估 9个月的期限。患者将完成以下 MSPR 领域的措施，包括可修改的 与疼痛相关的因素：1) 人口统计，2) 健康状况，3) 生物因素，4) 行为因素，5) 心理因素，6) 社会学的。总的来说，这些目标有可能促进对表型机制的理解 潜在的术后疼痛影响和身体功能轨迹，可能是朝着发展迈出的一步 旨在促进患者康复并减轻总体疼痛负担的治疗方式 正在进行关节置换术。