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 密歇根胸科和心血管学会开胸手术医院 外科医生(MSTCVS)质量协作。协作质量改进计划，包括MSTCVS 由密歇根州蓝十字蓝盾资助，进行参与式、供应商驱动的质量改进 我们的团队大量利用这些举措来研究术后疼痛和阿片类药物相关的结果 并生成最佳实践。这些最佳做法的实施和传播大大增加了 密歇根州减少了围手术期阿片类药物的处方，这种强有力的伙伴关系将使我们能够 从不同医疗保健系统的人群样本中招募开胸患者。我们会 从密歇根州的七家医院招募1800名通过胸部入路(肺)进行手术的患者 切除、食道切除/重建和其他普通胸部手术)。 我们于2020年8月加入A2CPS财团。从那时起，我们一直在与 财团协调我们的协议并为我们的研究发射做准备。通过多个工作组，我们 已确定需要对我们的协议和程序进行修改，以与 MCC1。此外，鉴于财团在我们加入之前一年多的工作中取得的进展， 财团已经达成协议，我们计划在今年第二季度开始招聘工作 第一季度，而不是第三季度。

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 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 joined the A2CPS Consortium in August 2020. Since that time, we have worked with the consortium to harmonize our protocols and prepare for our study launch. Through the multiple workgroups, we have determined that amendments to our protocols and procedures will be needed to harmonize with the MCC1. Moreover, given the progress made by the consortium in the more than year of work before we joined the consortium have made it such that we plan to launch our recruitment efforts in the second quarter of year one instead of the third quarter.