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

慢性手术后疼痛(CPSP)已被认为是一个终生的主要健康问题。 接受侵入性肌肉骨骼手术的青少年患CPSP的风险尤其高，这种疾病发生在 约20%的年轻人术后。CPSP与严重的功能残疾和体力减退有关 和心理社会健康相关的生活质量。青春期的慢性疼痛也会使个人面临患上 成年期的慢性疼痛以及物质使用障碍的风险，产生潜在的终生 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 在接受大手术的青少年中，我们证明(1)发展为CPSP的青少年可能遵循不同的 术后前2周内出现的康复模式，以及(2)基线心理社会风险 因素预测CPSP的发展。然而，还需要进一步的研究来了解经济衰退期间的复苏。 手术后最初几周，急性术后疼痛开始过渡到CPSP。尽管有 先前的研究表明，心理社会因素可能在CPSP中发挥作用，但关于 影响从急性疼痛到慢性疼痛的进一步生物-心理-社会机制 青少年的肌肉骨骼外科。这些知识上的差距限制了发展和 针对急性向CPSP过渡机制的围手术期干预措施的实施 积极改变术后恢复的轨迹。因此，本项目的目标是：1)开发有效和可靠的 使用疼痛、睡眠质量、情绪和身体功能的短期轨迹的急性恢复指数 脊柱融合术后的前30天，2)确定心理社会和心理物理 手术后疼痛从急性向慢性转变的机制。为了达到这些目标，我们 建议对160名10至18岁接受脊柱手术的青年进行两点前瞻性纵向队列研究 融合手术和他们的父母。将对疼痛、健康和功能结果进行前瞻性评估 分别于术前和术后6个月内的3个时间点采集数据。手术后立即， 青少年将在前30天完成对疼痛、睡眠质量、情绪和身体功能的日常监测 出院后天数采用生态瞬时评估。这些数据将用于开发 术后3个月和6个月预测CPSP的有效和可靠的急性恢复指标。我们将衡量 从急性向CPSP转变的两套可能的机制，心理社会变量和 基于实验室的心理生理疼痛反应，手术前和术后8周，以便 确定对CPSP后续发展的时间影响。这项研究将增加对 从急性到慢性手术后疼痛的转变以及所涉及的原因机制。长期的 该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.