Severe Pain During Wound Care Procedures: Model and Mechanisms

 描述（由申请人提供）：伤口护理程序（如敷料更换）导致74%的患者出现中度至重度疼痛，其中近一半（36%）患者出现重度疼痛（在10分数字评定量表上评定为8至10分）。严重的疼痛会给病人和护士带来巨大的压力。不幸的是，WCP期间严重疼痛的高患病率未得到充分认识和研究。迄今为止，预防WCP期间疼痛的主要建议集中在预防性和程序性镇痛或使用昂贵的非粘性敷料。然而，目前尚不清楚哪些患者需要镇痛或昂贵的敷料，导致其不适当的过度或不足的使用。只有23%的接受WCP的患者使用止痛药，而使用可能减轻疼痛的敷料的患者更少。迫切需要预测哪些患者在WCP期间可能出现严重疼痛的能力，以便他们可以成为预防性疼痛控制策略的目标，包括使用阿片类镇痛药和特殊敷料。本研究的目的1是开发和评估一个模型，以预测严重疼痛在WCP。虽然阿片类药物通常用于高度疼痛的情况，但它们可能不是控制开放性伤口疼痛的最佳或适当策略，因为它们会损害伤口愈合并可能导致伤口慢性化。阿片类药物的替代品非常有限，因为在WCP期间导致伤害敏感性和高度疼痛的生物学机制尚不清楚。了解这些机制将指导制定新的有效干预措施。第二个目标是确定这些机制。我们已经组建了一个特殊的多学科调查小组，以执行这一建议的目标。这些研究人员包括具有以下专业知识的研究人员：慢性伤口的临床研究（PI：Gardner），临床（研究人员：Rakel）和 基础科学（顾问：Brennan）疼痛研究、测量伤口生物负载的基因组技术（研究者：Grice）和统计分析，包括受试者工作曲线（Staecian：Hillis）。为了实现研究目的，将在450例开放性伤口住院患者的样本中，同时测量伤口、患者和生物学因素的综合集合以及敷料更换期间的疼痛。将开发预测模型，并使用逻辑回归检查生物学机制。将使用受试者操作者特征曲线对模型进行评价。这项拟议的研究有可能做出重大贡献，因为临床医生将能够针对那些需要预防性疼痛控制的患者，从而消除疼痛程序对伤害感受器敏感化的螺旋式影响。此外，研究结果将为开发所需的新型疼痛控制策略提供基础证据。积极的影响将是优化伤口护理，最大限度地减少疼痛和治疗的不良影响，并降低与伤口护理相关的成本。

 DESCRIPTION (provided by applicant): Wound care procedures, such as dressing changes, cause moderate to severe pain in 74% of patients, nearly half (36%) of whom experience severe pain (rated as 8 to 10 on a 10-point numeric rating scale). Severe pain causes substantial stress for both patient and nurse. Unfortunately, the high prevalence of severe pain during WCPs is under-recognized and under-studied. To date, mainstay recommendations to prevent pain during WCPs have focused on either administration of preventive and procedural analgesia or use of expensive, non-adherent dressings. However, it is unclear which patients to target for analgesia or expensive dressings, leading to their inappropriate over or under use. Analgesics are given to only 23% of patients undergoing WCPs and dressings that may decrease pain are given to even fewer. The ability to predict which patients are likely to have severe pain during WCPs is critically needed so that they can be targeted for preventive pain control strategies, including use of opioid analgesics and special dressings. Aim 1 of this study is to develop and evaluate a model to predict severe pain during WCPs. Although opioids are often given for highly painful conditions, they may not be an optimal or adequate strategy for controlling pain in open wounds because they impair wound healing and could lead to wound chronicity. The arsenal of alternatives to opioids is extremely limited because the biological mechanisms that contribute to nociceptive sensitivity and high pain during WCPs are unknown. Knowledge of these mechanisms would direct the development of new, effective interventions. Aim 2 is to identify these mechanisms. We have assembled an exceptional multi-disciplinary team of investigators to execute the aims of this proposal. These include investigators with expertise in: clinical research of chronic wounds (PI: Gardner), clinical (Investigator: Rakel) and basic science (Consultant: Brennan) research of pain, genomic technologies to measure wound bioburden (Investigator: Grice), and statistical analyses, including receiver operating curves (Statistician: Hillis). To achieve the aims of the study, a comprehensive set of wound, patient, and biological factors will be measured concurrently with pain during a dressing change among a sample of 450 inpatients with open wounds. A predictive model will be developed and biological mechanisms will be examined using logistic regression. The model will be evaluated using receiver operator characteristic curves. The proposed study has the potential to make significant contributions because clinicians will be able to target those patients requiring preventive pain control, thereby eliminating the spiraling impact of painful procedures on nociceptor sensitization. In addition, the findings will provide foundational evidence for the development of needed, novel pain control strategies. The positive impact will be to optimize wound care, minimize adverse effects of pain and treatment, and reduce the costs associated with wound care.