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: 10458646
• 负责人: Chad M Brummett
• 金额: $ 70万
• 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 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10458646
• 关键词: Acute; Anxiety; Biological; Biological Markers; Blood specimen; Blue Cross; Blue Shield; Budgets; Cardiovascular system; Caring; Cellular Phone; Chest; Child; Chronic; Clinical; Clinical Trials; Complement; Data; Data Element; Development; 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; Patient Recruitments; Patient Self-Report; Patients; Perioperative; Phenotype; Play; Population; Postoperative Pain; Postoperative Period; Prevention; Procedures; Prospective Studies; Proteomics; Provider; Repeat Surgery; Reporting; Research; Research Design; Resolution; Resources; Risk Factors; Role; Sample Size; Sampling; Science; Sensory; Site; Societies; Surgeon; Testing; Thoracic Surgical Procedures; Thoracotomy; United States National Institutes of Health; Universities; Work; base; biomarker selection; chronic pain; chronic pelvic pain; clinical center; clinical pain; cohort; design; diagnostic criteria; experience; high risk; hip replacement arthroplasty; knee replacement arthroplasty; metabolomics; neuroimaging; novel; pain chronification; pain processing; pain symptom; population based; prescription opioid; prevent; programs; reconstruction; recruit; rheumatologist; risk variant; sample collection; success; web-enabled

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 A2CP 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 co-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 will capture patient-reported health status alongside QST and functional neuroimaging at baseline and 6 months using a novel smart phone- and web-enabled application. At baseline and 6 months, biological samples will also be collected. From the 1800 participants recruited, we will identify 200 cases and 200 controls of CPSP at 6 months after surgery for repeated neuroimaging, quantitative sensory testing and blood sample collection. The successful completion of the proposed study would provide an unparalleled resource for the understanding the factors associated with CPSP and will allow for more efficient and personalized trials to prevent the development of chronic pain after thoracotomy and other thoracic surgeries.

项目总结/摘要 慢性手术后疼痛（CPSP）是新的慢性疼痛的主要原因，在手术后发生10 - 40%。 普通外科手术胸外科手术的慢性术后并发症发生率最高， 手术疼痛（CPSP），大约30 - 47%的患者在术后6个月内出现新的慢性疼痛。 手术虽然胸外科手术后CPSP的高发病率得到了很好的描述，但患者和护理 与CPSP发展相关的因素尚不清楚。一些因素，如焦虑， 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 神经成像、定量感觉测试和用于基因组学、代谢组学和蛋白质组学的血液样本。 我们认为，胸外科手术是一个理想的第二次手术人群，以增加急性至慢性疼痛 签名（A2 CPS）计划，补充了膝关节置换术的第一个MCC人群，该人群具有 新的CPSP发生率较低，但它是一个更好的队列，以确定未能解决慢性疼痛的风险因素。我们 来自拟议中的密歇根大学A2 CP多站点临床中心（MCC）的跨学科团队已经 无与伦比的专业知识来检查CPSP发展的表型和基因型风险因素 在接受胸外科手术的患者中。我们的合作伙伴包括一名麻醉师，两名外科医生， 在正在进行的工作中成功合作的风湿病学家，以及全州网络内的合作伙伴， 进行开胸手术的医院，密歇根州胸科协会， 心血管外科医生（MSTCVS）质量协作。协作质量改进计划 包括MSTCVS由密歇根州的蓝十字蓝盾资助， 质量改进计划，我们的团队已经充分利用这些来研究术后疼痛， 与类阿片有关的成果并产生最佳做法。执行和传播这些最佳做法， 实践已经大大减少了密歇根州阿片类药物的围手术期处方，这一强大的 合作伙伴关系将使我们能够从不同的人群中招募开胸手术患者， 医疗保健系统。我们将从密歇根州的七家医院招募1800名患者， 胸部手术（肺切除术、食管切除/重建术和其他普通胸部手术）。 我们将在基线和第6天采集患者报告的健康状况以及QST和功能性神经影像学。 几个月使用一个新的智能手机和网络功能的应用程序。在基线和6个月时，生物 并会收集样本。从招募的1800名参与者中，我们将确定200个病例， 术后6个月，CPSP对照组进行重复神经成像、定量感觉测试和血液检查， 样本采集成功完成拟议的研究将为以下方面提供无与伦比的资源： 了解与CPSP相关的因素，并将允许更有效和个性化的试验， 预防开胸手术和其他胸部手术后慢性疼痛的发展。