Transition from Acute to Chronic Pain After Thoracic Surgery

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。我们的私家侦探包括一名麻醉师，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， 密歇根州胸心血管协会（Michigan Society of Thoracic and Cardiovascular） 外科医生（MSTCVS）质量协作。包括MSTCVS在内的协作质量改进计划 由密歇根州的蓝十字蓝盾资助，进行参与式的、提供商驱动的质量改进 我们的团队已经充分利用这些措施来研究术后疼痛和阿片类药物相关的结局 并产生最佳实践。这些最佳做法的实施和传播大大提高了 减少密歇根州阿片类药物的围手术期处方，这种强大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手术患者。我们将 从密歇根州的七家医院招募了1800名患者，他们正在接受经胸入路（肺）的手术 切除术、食管切除术/重建术和其他普通胸外科手术）。 我们于二零二零年八月加入A2 CPS联盟。从那时起，我们与 联盟协调我们的协议，并为我们的研究启动做准备。通过多个工作组，我们 我已经确定，我们的协议和程序的修正案将需要与协调， MCC1。此外，在我们加入之前，联合体在一年多的工作中取得了进展， 我们计划在今年第二季展开招聘工作 一个而不是第三季度。

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.