Mechanism-based Approach to Pain in Chronic Pancreatitis (MAP-CP Study)

项目摘要 慢性胰腺炎(CP)常伴有难以治疗的极度虚弱的疼痛。有一种 大量可以开处方的止痛药，但它们的有效性往往取决于对 疼痛的原因和类型。由于临床上还没有工具来正确地描述疼痛的亚型 患者正在经历，很难选择一种最有可能提供足够疼痛缓解的治疗方法。身份的鉴定 与特定疼痛亚型相关的生物标记物特征可以为疼痛管理指南提供信息，从而改善 通过减少实施有效治疗所需的时间和费用，降低患者的生活质量 使用阿片类药物的患者数量，并确定新的治疗靶点。这项研究旨在检验这一假说 患者派生的信息可用于识别疼痛表型(生物标记物档案)， CP相关疼痛的处理。目标1将是横断面分析，以检查循环的表达模式 已知对疼痛信号很重要的蛋白质。我们将把这些与疼痛特征进行比较 以前的研究包括疼痛强度、频率和对生活质量的干扰。到时候我们会的 确定是否可以根据潜在的疼痛区分假定的生物标志物特征和疼痛特征 机制(伤害性与神经性)。目标2将涉及纵向评估是否存在时间变化 生物标记物特征与临床症状和治疗的变化有关，如阿片类药物。这项纵向研究 将使我们能够描述相同患者体内疼痛的自然历史。总的来说，这项研究的结果将 提供有关CP患者疼痛演变的深入数据，并指导未来旨在预测治疗效果的研究 反应能力和制定有效的干预措施。

Project Summary Chronic pancreatitis (CP) is often accompanied by profoundly debilitating pain that is quite difficult to treat. There are a large number of analgesics that can be prescribed, but their efficacy often depends on having a mechanistic assessment of the cause and type of pain. Since there are no tools available in clinics to properly characterize the sub-type of pain a patient is experiencing, it is difficult to choose a therapy most likely to provide sufficient pain relief. The identification of biomarker profiles associated with specific sub-types of pain could inform guidelines for pain management that improve patients' quality of life by reducing the time and expense required to administer the efficacious therapies, reduce the number of patients prescribed opioids, and identify novel therapeutic targets. This study is designed to test the hypothesis that patient-derived information can be used to identify pain phenotypes (biomarker profiles) that inform management of CP-related pain. Aim 1 will be cross-sectional analyses to examine the expression pattern of circulating proteins that are known to be important for pain signaling. We will compare these in relation to pain characteristics that have been previously studied including pain intensity, frequency, and interference with quality of life. We will then determine if putative biomarker profiles and pain characteristics can be differentiated based on the underlying pain mechanism (nociceptive versus neuropathic). Aim 2 will involve longitudinal evaluation of whether temporal changes in biomarker profile are associated with changes in clinical symptoms and treatment, such as opioids. This longitudinal study will allow us to describe the natural history of pain within the same patients. Overall, the results from this study will provide in depth data regarding the evolution of pain in CP and guide future studies aimed at predicting therapeutic responsiveness and developing efficacious interventions.