Chronic Postsurgical Pain Across the Lifespan: Brain State and Treatment

项目摘要 问题陈述： 慢性手术后疼痛(CPSP)，定义为术后持续两个月以上的疼痛，是一种显著的 公共卫生问题影响到高达80%的手术患者。有影响深远的 对受CPSP影响的人的生活质量以及身体和情绪功能的影响 使这一危机复杂化的是手术后开出的阿片类药物的数量，超过80%的患者接受了 低风险手术后的阿片类药物处方。缺乏综合性研究和有效的治疗策略。 实验室研究概述： 我的赠款资助的研究，包括我目前的K23奖，一直专注于识别生物心理社会 通过使用临床前和临床模型并假设CPSP的寿命视角来预测CPSP 确定CPSP的预测因素和预防。2013年，我发表了迄今为止规模最大的前瞻性研究 确定青年CPSP的长期疼痛轨迹和预测因素以及2018年目标1的结果 我的K23奖，利用了CPSP的动物模型，获得了编辑的选择。我的方法是将临床， 心理和大脑测量，以了解有助于 CPSP的演变或恢复能力。 未来5年的目标： 在接下来的5年里，我将继续使用转换的方法来检查CPSP的风险因素，并扩展 根据我的K23工作：1)利用心理物理学和神经成像来了解CPSP对突触的影响 从青春期到成年期的可塑性2) 评估循证行为疼痛的效果 与常规治疗相比，对青少年和成人患者组的fNIRS信号进行干预 诊断为CPSP，以便比较应答者(疼痛严重程度、干预和 功能)与非响应者。 Mira中概述的项目将由我的下一任 与在外科、疼痛心理物理学、神经科学和 神经成像。 研究计划的总体愿景： R35的目标将是：1)加强我们对CPSP神经生物学的理解；2)提供一种衡量标准 在临床上跟踪CPSP患者；3)为那些将被慢性化的患者提供一个衡量标准；4)了解年龄- CPSP中的相关差异；以及5)确定了可能增强我们的开发能力的初始范式 在行为学和药理学层面上，为患者量身定做干预措施。

Project Summary Statement of the Problem: Chronic post-surgical pain (CPSP), defined as pain lasting longer than two-months after surgery, is a significant public health problem affecting up to 80% of patients presenting for surgery. There are far-reaching consequences for quality of life and physical and emotional functioning for those affected by CPSP and complicating this crisis is the number of opioids prescribed after surgery with over 80% of patients receiving opioid prescriptions after low-risk surgery. Integrative research and effective treatment strategies are lacking. Overview of Research in the Laboratory: My grant funded research, including my current K23 Award, has focused on identifying biopsychosocial predictors of CPSP through the use of pre-clinical and clinical models and assuming a life-span perspective for identifying predictors and prevention of CPSP. In 2013, I published the largest prospective study to date identifying long-term pain trajectories and predictors of CPSP in young people and in 2018 results of Aim 1 of my K23 Award, utilizing an animal model of CPSP, received Editor’s Choice. My approach is to integrate clinical, psychological, and brain measures in order to understand the neurobiological processes that contribute to the evolution or resilience of CPSP. Goals for the Next 5 Years: In the next 5 years, I will continue to utilize a translational approach to examine risk factors for CPSP and extend upon my K23 work to: 1) utilize psychophysics and neuroimaging to understand the effects of CPSP on synaptic plasticity from adolescence into adulthood and 2) evaluate the effects of an evidence-based behavioral pain intervention, compared to Treatment as Usual, on the fNIRS signal in groups of adolescent and adult patients diagnosed with CPSP in order to compare Responders (improvement in pain severity, interference, & functioning) vs. Non-Responders. The projects outlined in the MIRA will be accomplished by my continued collaborations with colleagues who have expertise in surgery, pain psychophysics, neuroscience, and neuroimaging. Overall Vision of the Research Program: The goals of the R35 will be to: 1) enhance our understanding of the neurobiology of CPSP; 2) provide a metric to follow patients with CPSP in the clinic; 3) provide a metric for those who will chronify; 4) understand the age- related differences in CPSP; and 5) define an initial paradigm that may enhance our capability for developing individually tailored patient-oriented interventions at both a behavioral and pharmacological level.