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: 10444038
• 负责人: Chad M Brummett
• 金额: $ 25万
• 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/10444038
• 关键词: Acute; Amendment; Anxiety; Biological Markers; Blood Specimen Collection; 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; Patients; Perioperative; Phenotype; Play; Population; Postoperative Pain; Postoperative Period; Prevention; Procedures; Proteomics; Protocols documentation; Provider; Research; Research Design; Resolution; Risk Factors; Role; Sample Size; Sampling; Science; Sensory; Societies; Surgeon; Testing; Thoracic Surgical Procedures; Thoracotomy; United States National Institutes of Health; Universities; Work; 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; programs; reconstruction; recruit; rheumatologist; risk variant; success

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 A2CPS 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 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 have worked with the A2CPS consortium to harmonize our protocols and prepare for our study launch. Through the multiple workgroups, we have determined that amendments to our protocols and procedures will be needed to harmonize with the MCC1 given the progress made by the consortium in the more than year of work before we joined.

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，但可以更好地识别无法解决慢性疼痛的风险因素。我们的 来自拟建的密歇根大学 A2CPS 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危险因素 在接受胸外科手术的患者中。我们的 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、密歇根胸外科和心血管外科医生协会 (MSTCVS) 质量协作。包括 MSTCVS 在内的协作质量改进计划获得资助 由密歇根州 Blue Cross Blue Shield 实施参与式、供应商驱动的质量改进举措， 我们的团队充分利用这些来研究术后疼痛和阿片类药物相关的结果， 生成最佳实践。这些最佳实践的实施和传播极大地促进了 密歇根州减少了阿片类药物的围手术期处方，这种强有力的伙伴关系将使我们能够 从不同医疗系统的人群样本中招募开胸手术患者。我们将 从密歇根州的 7 家医院招募 1800 名患者，接受胸腔手术（肺 切除、食管切除/重建和其他普通胸外科手术）。我们曾与 A2CPS 联盟负责协调我们的协议并为我们的研究启动做准备。通过多重 工作组，我们已确定需要对我们的协议和程序进行修订 鉴于该联盟在一年多的工作中取得的进展，与 MCC1 协调一致 加入了。