Transition from Acute to Chronic Pain After Thoracic Surgery

项目摘要/摘要 慢性手术后疼痛(CPSP)是新的慢性疼痛的主要原因，发生在10%-40%的手术后 常见的外科手术。胸外科手术的慢性后遗症发生率最高。 外科疼痛(CPSP)，大约30%-47%的患者在术后6个月内出现新的慢性疼痛 做手术。虽然胸部手术后CPSP的高发病率是众所周知的，但患者-和护理- 与CPSP发展有关的因素仍然不清楚。一些因素，如焦虑，已经被 然而，大多数队列缺乏评估潜在重要因素的样本量，包括 神经成像，定量感觉测试，以及基因组学、代谢组学和蛋白质组学的血液样本。 我们认为胸外科是增加急慢性疼痛的理想二次手术人群。 Signature(A2CPS)计划，补充了膝关节置换的第一个MCC群体，该群体有很多 新的CPSP发生率较低，但是确定未能解决慢性疼痛的风险因素的更好队列。我们的 密歇根大学拟建的A2CP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，检查CPSP发展的表型和遗传型风险因素 在接受胸部手术的患者中。我们的合作PI包括一名麻醉师、两名外科医生和一名 风湿病学家在正在进行的工作中成功地合作，并在全州范围的 进行开胸手术的医院，密歇根胸科学会和 心血管外科医生(MSTCVS)优质协作。协作性质量改进计划 包括MSTCVS，由密歇根州蓝十字蓝盾资助，开展参与性、提供商驱动的 质量改进举措，我们的团队大量利用这些举措来研究术后疼痛--以及 取得与阿片类药物相关的成果，并产生最佳做法。这些最佳做法的实施和传播 在密歇根州，实践大大减少了围手术期阿片类药物的处方，这一点很强 合作伙伴关系将使我们能够从不同领域的人群样本中招募开胸患者 医疗保健系统。我们将从密歇根州的七家医院招募1800名通过 胸入路(肺切除、食道切除/重建和其他普通胸外科手术)。 我们将收集患者报告的健康状态以及QST和功能神经成像在基线和6 使用一款支持智能手机和网络的新型应用程序。在基线和6个月时，生物 还将收集样本。从招募的1800名参与者中，我们将确定200个病例和200个 CPSP患者术后6个月复查神经影像、定量感觉检查及血常规对照 样本收集。拟议研究的成功完成将提供无与伦比的资源 了解与CPSP相关的因素，将允许更有效和个性化的试验 防止开胸手术和其他胸部手术后出现慢性疼痛。

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.