Mechanisms of transition from acute to chronic pain in youth undergoing musculoskeletal surgery

慢性手术后疼痛（CPSP）已被公认为整个生命周期的主要健康问题。 接受侵入性肌肉骨骼手术的青少年特别容易患CPSP， 大约20%的年轻人在手术后。CPSP与严重的功能障碍和身体功能降低有关。 和心理健康相关的生活质量。青春期的慢性疼痛也会使个体面临以下风险： 成年后的慢性疼痛，以及物质使用障碍的风险， 对功能、生产力和生活质量的影响。在我们自己的小样本初步研究中， 我们证明，（1）发生CPSP的青少年可能遵循不同的 术后前2周内出现的恢复模式，以及（2）基线心理社会风险 预测CPSP发展的因素。然而，还需要进一步的研究来了解恢复期间， 术后最初几周，急性术后疼痛开始转变为CPSP。虽然 先前的研究表明，心理社会因素可能在CPSP中发挥作用，但有关 进一步的生物心理社会机制，影响从急性过渡到慢性疼痛后， 青少年肌肉骨骼手术。这些知识上的差距限制了发展， 实施针对从急性向CPSP过渡机制的围手术期干预措施 积极地改变术后恢复的轨迹。因此，本项目旨在1）开发有效和可靠的 急性恢复指数，使用短期的疼痛轨迹，睡眠质量，情绪和身体功能， 脊柱融合手术后的前30天，以及2）确定心理社会和心理物理 导致从急性到慢性术后疼痛转变的机制。为了实现这些目标，我们 建议在160名年龄在10至18岁之间接受脊柱手术的青少年中进行一项2中心前瞻性纵向队列研究 还有他们的父母将对疼痛、健康和功能结局进行前瞻性评估， 在手术前和手术后6个月期间的三个时间点收集。手术后， 青少年将在前30年完成对疼痛、睡眠质量、情绪和身体功能的日常监测， 使用生态学瞬时评估，在出院后的天数内。这些数据将用于开发 预测术后3个月和6个月CPSP的有效和可靠的急性恢复指数。我们将测量 从急性向CPSP过渡的两组潜在机制，心理社会变量和 在术前和术后8周时进行基于实验室的心理物理疼痛反应， 确定对CPSP后续发展的时间影响。这项研究将增进对 手术后疼痛从急性到慢性的转变及其因果机制。长期 本研究计划的目标是开发有效的围手术期干预措施，以减少阿片类药物的暴露 并降低接受肌肉骨骼手术的青少年中CPSP的发生率。

Chronic postsurgical pain (CPSP) has been recognized as a major health concern across the lifespan. Adolescents undergoing invasive musculoskeletal surgeries are particularly at risk for CPSP, which occurs in about 20% of youth after surgery. CPSP is associated with significant functional disability and reduced physical and psychosocial health-related quality of life. Chronic pain in adolescence also places individuals at risk for chronic pain in adulthood, as well as risk for substance use disorder, generating potential lifelong consequences on functioning, productivity, and quality of life. In our own preliminary studies in a small sample of adolescents having major surgery, we demonstrated that (1) youth who develop CPSP may follow distinct recovery patterns that emerge within the first 2 weeks following surgery, and (2) baseline psychosocial risk factors predict development of CPSP. However, further studies are needed to understand recovery during the initial weeks following surgery when acute postsurgical pain begins to transition to CPSP. Although there is indication from prior studies that psychosocial factors may play a role in CPSP, there has been limited data on further biopsychosocial mechanisms that influence the transition from acute to chronic pain after musculoskeletal surgery in adolescents. These gaps in knowledge have limited the development and implementation of perioperative interventions targeted at the mechanisms of the transition from acute to CPSP to positively alter the trajectory of postsurgical recovery. Thus, this project aims to 1) develop valid and reliable acute recovery indices using short-term trajectories of pain, sleep quality, mood, and physical function over the first 30 days following spinal fusion surgery, and 2) determine the psychosocial and psychophysical mechanisms contributing to the transition from acute to chronic postsurgical pain. To address these aims, we propose a 2-site prospective longitudinal cohort study in 160 youth aged 10 to 18 years undergoing spinal fusion surgery, and their parents. Prospective assessments of pain, health, and functional outcomes will be collected before surgery and at three time points during the 6 months after surgery. Immediately after surgery, adolescents will complete daily monitoring of pain, sleep quality, mood, and physical function in the first 30 days following hospital discharge using ecological momentary assessment. These data will be used to develop valid and reliable acute recovery indices that predict CPSP at 3 and 6 months post-surgery. We will measure two potential sets of mechanisms underlying the transition from acute to CPSP, psychosocial variables and laboratory-based psychophysical pain responses, before surgery and at 8-weeks post-surgery in order to determine the temporal influence on subsequent development of CPSP. This study will increase understanding of the transition from acute to chronic postsurgical pain and the causal mechanisms involved. The long-term goal of this research program is to develop effective perioperative interventions to reduce exposure to opioids and decrease incidence of CPSP in adolescents undergoing musculoskeletal surgeries.