Biobehavioral Risk Factors for Persistent Pain following Total Knee Arthroplasty

全膝关节置换术后持续疼痛的生物行为危险因素

• 批准号: 8101280
• 负责人: ROBERT R EDWARDS
• 金额: $ 66.57万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8101280
• 关键词: Age; Analgesics; Architecture; Area; Behavioral; Blood; Chronic disabling pain; Cohort Studies; Data; Degenerative polyarthritis; Development; Economic Burden; Evaluation; Group Identifications; Hospitals; Imaging Techniques; Individual; Individual Differences; Inflammatory Response; Influentials; International Health Problems; Investigation; Knee; Knee Osteoarthritis; Maintenance; Measures; Minority; Modeling; Musculoskeletal Pain; Operative Surgical Procedures; Outcome; Pain; Pain management; Patients; Persistent pain; Physical Examination; Physical Function; Physical Sufferings; Physiological; Play; Population; Postoperative Pain; Postoperative Period; Preventive Intervention; Procedures; Process; Psychophysiology; Publishing; Questionnaires; Relative (related person); Replacement Arthroplasty; Reporting; Risk; Risk Factors; Role; Saliva; Sampling; Shapes; Site; Sleep; Sleep disturbances; Source; Specificity; Staging; Testing; biobehavior; central pain; chronic pain; cohort; design; disability; experience; follow-up; functional outcomes; high risk; improved functioning; indexing; inflammatory pain; interest; knee replacement arthroplasty; prospective; psychologic; psychosocial; public health relevance; response

DESCRIPTION (provided by applicant): Degenerative joint disease, particularly knee osteoarthritis (OA), is one of the most prevalent and disabling chronic pain conditions and is projected to increase sharply as the U.S. population ages. Projections also indicate that the annual number of total knee replacements, the treatment of choice for end-stage knee OA, will increase five- to ten-fold in the U.S. over the next several decades. While the outcomes following total knee arthroplasty are generally good, a substantial minority of patients continue to experience significant long-term pain and disability after surgery. These individual differences in the trajectory of pain and function after knee replacement are minimally related to findings from physical examination and imaging procedures. Our group has identified several potentially important variables that are likely to play a role in shaping long-term pain outcomes, though there are few published studies in patients with knee OA. The proposed 2-site prospective cohort project will carefully evaluate and follow a sample of patients undergoing total knee replacement. Knee OA patients will be assessed pre-surgically with a battery of psychophysical pain testing procedures, multimodal evaluation of sleep quality, continuity, and architecture, questionnaires regarding psychological function, and physiological sampling (e.g., blood and saliva samples). Outcomes such as pain, functioning, and analgesic usage will be evaluated through 12-month follow-up. These data will allow us to model the unique and combined impact of these classes of "risk factor" variables. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for selection of surgical patients and for management of post-operative pain, as well as theoretical importance in understanding the sources of individual differences in pain-related outcomes. PUBLIC HEALTH RELEVANCE: Chronic pain is a critical national and international health problem, making the identification of groups at high risk for the development or persistence of chronic pain an increasingly important area of investigation. This project seeks to identify risk factors for persistent pain and physical disability following total knee replacement, a surgical procedure projected to increase five- to ten-fold in the U.S. over the next several decades. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for the selection of surgical patients, for the management of post-operative pain, and for understanding the sources of individual differences in pain-related outcomes.

描述（由申请人提供）：退行性关节疾病，特别是膝关节骨关节炎（OA），是最普遍和致残的慢性疼痛疾病之一，预计将随着美国人口老龄化而急剧增加。预测还表明，全膝关节置换术（终末期膝关节OA的首选治疗）的年度数量在未来几十年内将在美国增加5至10倍。虽然全膝关节置换术后的结局通常良好，但仍有相当一部分患者在手术后继续经历显著的长期疼痛和残疾。膝关节置换术后疼痛和功能轨迹的这些个体差异与体格检查和影像学检查结果的相关性极小。我们的小组已经确定了几个潜在的重要变量，这些变量可能在塑造长期疼痛结局方面发挥作用，尽管在膝关节OA患者中发表的研究很少。拟定的2中心前瞻性队列项目将仔细评价并随访接受全膝关节置换术的患者样本。膝关节OA患者将在术前进行评估，包括一系列心理物理疼痛测试程序，睡眠质量、连续性和结构的多模式评价，关于心理功能的问卷调查和生理采样（例如，血液和唾液样本）。将通过12个月随访评价疼痛、功能和镇痛剂使用等结局。这些数据将使我们能够对这些类别的“风险因素”变量的独特和综合影响进行建模。总的来说，识别与关节置换术后持续性疼痛和疼痛相关残疾的发展和维持相关的因素，对手术患者的选择和术后疼痛的管理具有重要的实际意义，以及在理解疼痛相关结局的个体差异来源方面的理论重要性。 公共卫生相关性：慢性疼痛是一个严重的国家和国际健康问题，使识别慢性疼痛发展或持续的高风险群体成为越来越重要的调查领域。该项目旨在确定全膝关节置换术后持续疼痛和身体残疾的风险因素，预计在未来几十年内，全膝关节置换术在美国将增加五到十倍。总的来说，识别与关节置换术后持续性疼痛和疼痛相关残疾的发展和维持相关的因素，对于手术患者的选择，术后疼痛的管理以及理解疼痛相关结局的个体差异的来源具有重要的实际意义。