A Multisystem Resilience Approach in the Assessment of Postsurgical Pain Trajectories

项目总结/摘要 在美国，骨关节炎影响大约3000万人，并且是疼痛的主要原因， 老年人的残疾。全关节置换术（TJA）是最常见的择期手术之一， 难治性膝关节和髋关节炎患者。虽然一部分患者从TJA中获益，但 34%的患者在手术后出现慢性术后疼痛（CPSP），其中约33%的患者 患者经历高冲击或令人烦恼的疼痛。虽然TJA后CPSP的潜在风险因素 虽然已有大量文献记载，但预测治疗成功的恢复力机制的特征却很差 而不是常规评估。在先前研究的基础上，我们提出了一个新的疼痛弹性概念模型 它将弹性功能定义为一个涉及众多系统的动态和多维过程， 多系统疼痛恢复力（MSPR）在初步工作中，我们发现， 具有跨多个域的更大程度的保护资源的个体（即，心理的，社会的， 健康）表现出更佳的心理，身体和疼痛相关的功能时，与那些 一个较低的弹性表型。因此，调查广泛的适应因素可能会提供重要的 对资源的独特组合的预测性见解，这些资源可以解释弹性响应轨迹 在TJA之后根据精准医学倡议，这项前瞻性观察性研究的目的是 为了探索与接受膝关节和髋关节成形术的患者的治疗反应相关的机制， 并表征MSPR表型谱与疼痛影响和身体功能之间的关联 轨迹为了实现这一目标，将对300名年龄在18岁以上接受膝关节和髋关节置换术的患者进行 在基线和术后5个时间点对MSPR因素和结局进行前瞻性评估， 9-月期间。患者将完成以下MSPR领域的测量，包括可修改的 与疼痛相关的因素：1）人口统计学，2）健康，3）生物学，4）行为，5）心理，和6） 社会学的总的来说，这些目标有可能促进对表型机制的理解 潜在的术后疼痛影响和身体功能轨迹，可能是朝着发展的一步 旨在促进患者恢复和减轻整体疼痛负担的治疗方式 接受关节成形术

PROJECT SUMMARY/ABSTRACT Osteoarthritis affects approximately 30 million people in the United States and is the leading cause of pain and disability among older adults. Total joint arthroplasty (TJA) is among the most common elective surgery for patients with refractory knee and hip arthritis. Although a proportion of patients achieve benefits from TJA, up to 34% of patients develop chronic postsurgical pain (CPSP) following the procedure, with approximately 33% of patients experiencing high impact or bothersome pain. While risk factors underlying CPSP following TJA have been well documented, the mechanisms of resilience that predict treatment success are poorly characterized and not routinely assessed. Building on prior research, we propose a novel conceptual model of pain resilience that defines resilient functioning as a dynamic and multidimensional process that engages numerous systems, a concept referred to as multisystem pain resilience (MSPR). In our preliminary work, we have found that individuals with a greater degree of protective resources across multiple domains (i.e., psychological, social, health) exhibit more optimal psychological, physical, and pain-related functioning when compared to those with a lower resilient phenotype. Thus, investigating a broad range of adaptive factors may provide important predictive insights into the unique combination of resources that account for resilient response trajectories following TJA. In line with the Precision Medicine Initiative, the aims of this prospective observational study are to explore mechanisms associated with treatment response in patients undergoing knee and hip arthroplasty, and to characterize associations between MSPR phenotypic profiles with pain impact and physical function trajectories. To address this goal, 300 patients ages 18+ years undergoing knee and hip arthroplasty will undergo prospective assessments of MSPR factors and outcomes at baseline and at five postsurgical time points over a 9-month period. Patients will complete measures across the following MSPR domains comprised of modifiable factors associated with pain: 1) demographic, 2) health, 3) biological, 4) behavioral, 5) psychological, and 6) sociological. Collectively, these aims have the potential to advance understanding of phenotypic mechanisms underlying postsurgical pain impact and physical function trajectories and may be a step toward the development of therapeutic modalities aimed at promoting enhanced recovery and reducing overall pain burden in patients undergoing arthroplasty.