PREventing Pain after Surgery: A feasibility and acceptability study of Acceptance and Commitment Therapy for the prevention of chronic post surgical pain (PREPS)

摘要/摘要 该提案对NOT-AR-23-015做出了回应，两者都产生了对未来的支持性证据 预防慢性手术后疼痛(CPSP)的创新研究，并通过以下方式扩大现有项目 通过一种新的方法收集关于疼痛的免疫机制和健康的社会决定因素的数据 协作。接受脊柱手术的患者中有很大一部分经历了手术后的慢性疼痛， 这个问题在黑人患者中比白人患者中更普遍。这可能在一定程度上是由于 SDoH与遗传学的相互作用。差异DNA甲基化(DNaM)与慢性后 手术疼痛以及SDoH，因此可能有助于解释种族差异的慢性手术后疼痛。 此外，有证据表明，身心干预可能会通过改变dNaM模式而带来好处。 有必要更好地了解dNaM在制定国家方案战略计划方面的作用及其程度。 作为接受和承诺疗法预防CPSP的机制。现在 该项目将利用接受和承诺疗法治疗的随机对照试验 对100名计划接受脊柱手术的患者进行常规与常规治疗的比较。在这份提案中，我们 将确定dNaM模式与SDoH关联的程度，检查 DNaM模式和CPSP，并探索接受和承诺疗法的影响程度 与dNaM模式的变化有关。这种方法将使我们能够更好地理解 CPSP的机制包括SDoH和遗传过程之间复杂的相互作用。此外，我们 将进一步阐明心身干预的生物学机制，如成就和承诺 治疗对预防慢性疼痛的作用。总而言之，这项研究的结果将为旨在 减少疼痛差异和不平等。

Summary/Abstract This proposal responds to NOT-AR-23-015 by both generating supportive evidence toward a future innovative study for the prevention of chronic postsurgical pain (CPSP) and expanding the current project by collecting data on immune mechanisms of pain and social determinants of health (SDoH) through a new collaboration. A large subset of patients who undergo spine surgery experience chronic post-surgical pain, a problem that is more prevalent among Black compared to White patients. This may be due, in part, to the interaction between SDoH and genetics. Differential DNA methylation (DNAm) is associated with chronic post- surgical pain as well as SDoH and thus may help to explain race differences chronic post-surgical pain. Moreover, there is evidence that mind-body interventions may confer benefit by modifying DNAm patterns. There is a need to better understand the role of DNAm in the development of CPSP and the extent to which it serves as a mechanism of Acceptance and Commitment Therapy on the prevention of CPSP. The present project will capitalize on a randomized, controlled trial of Acceptance and Commitment Therapy + treatment as usual compared to treatment as usual in 100 patients scheduled to undergo spine surgery. In this proposal we will determine the extent to which DNAm patterns are associated with SDoH, examine the relationship between DNAm patterns and CPSP, and explore the extent to which effects of Acceptance and Commitment Therapy are associated with changes in DNAm patterns. This approach will allow us to better understand the mechanism of CPSP including the complex interaction between SDoH and genetic processes. Moreover, we will further elucidate biological mechanisms of mind-body interventions such as Accetance and Commitment Therapy in the prevention of chronic pain. Together, results of this study will inform interventions aimed at reducing pain disparities and inequities.