Differential Susceptibility for Developing Chronic Post-Surgical Pain Across Sleep Trajectories and Inflammatory Presentations

不同睡眠轨迹和炎症表现对慢性术后疼痛的易感性存在差异

• 批准号: 10572513
• 负责人: Nicholas A Giordano
• 金额: $ 19.28万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10572513
• 关键词: Acute; Acute Pain; Area; C-reactive protein; Characteristics; Chronic; Classification; Clinical Research; Data; Data Collection; Development; Devices; Drowsiness; Drug usage; Electronics; Event; Hyperalgesia; Impairment; Incidence; Individual; Inflammation; Inflammatory; Interleukins; Intervention; Leadership; Link; Longitudinal Studies; Measures; Mentors; Modeling; Monitor; National Institute of Drug Abuse; Nature; Operative Surgical Procedures; Opioid; Orthopedic Surgery; Outcome; Pain; Pain intensity; Pain management; Participant; Pathway interactions; Patient Self-Report; Patients; Perioperative; Pharmaceutical Preparations; Postoperative Pain; Postoperative Period; Predisposition; Prospective Studies; Quality of life; Reaction; Records; Replacement Arthroplasty; Reporting; Research; Risk; Risk Estimate; Role; Scientist; Shoulder; Sleep; Sleep Deprivation; Sleep disturbances; Slow-Wave Sleep; Symptoms; System; TNF gene; Time; Visualization; actigraphy; biopsychosocial; career development; chronic pain; chronic pain patient; common symptom; cytokine; experience; improved; inflammatory marker; monitoring device; nociceptive response; novel; opioid therapy; opioid use; pain chronification; pain outcome; pain sensitivity; patient oriented; poor sleep; prescription opioid; prevent; skills; sleep pattern; sleep quality; systemic inflammatory response; wearable device

PROJECT SUMMARY Insufficient and poor sleep is pervasive among individuals with shoulder conditions requiring surgical intervention. Impaired preoperative sleep has been shown to induce hyperalgesia, predict the onset of painful episodes, and result in worse postoperative pain outcomes. Given the contributing role unmanaged acute pain has on developing chronic pain, patients with s hortened sleep and increased sleep disturbances (e.g., inefficient sleep) may be at greater risk for developing chronic post-surgical pain. Research shows the utility of pain trajectories to predict the development of chronic post-surgical pain, yet there is a dearth of research examining how changes in sleep contribute to the development of chronic post-surgical pain, despite evidence showing sleep impacts pain. One pathway through which poor sleep may contribute to chronic pain is through increased systemic inflammation. Shortened sleep and increased sleep disturbances induce an outsized inflammatory reaction, including upregulating cytokines, which sensitizes the nociceptive response and may increase susceptibility for developing chronic post-surgical pain. As many as 1 in 5 patients undergoing shoulder arthroplasty require prolonged opioid therapy for pain management. To date, postoperative opioid utilization has been assessed predominantly using patient self-report or dispensing records, with little known regarding real- time postoperative opioid use trajectories. This prospective study seeks to elucidate sleep presentations, as well as underlying inflammatory changes, that catalyze the acute to chronic pain transition after shoulder arthroplasty. This will be accomplished by leveraging actigraphy sleep-related data and medication utilization data collected daily using electronic monitoring from participants pre- and postoperatively and pairing those data with biopsychosocial outcomes and inflammatory markers up to 3-months later. This study aims to characterize and classify sleep trajectories prior to and after shoulder arthroplasty via actigraphy devices. Additionally, this study will examine the development of chronic post-surgical pain and real time opioid utilization, captured using Medication Event Monitoring Systems (MEMS) caps, across sleep trajectories. Finally, this study will compare longitudinal changes in inflammatory markers and subsequent development of chronic pain. These research aims reflect the PI’s career development objectives to develop expertise in the areas of cytokine research, implement actigraphy devices and MEMS into prospective studies for real-time objective data collection, analyze and visualize longitudinal data, and to develop vital leadership skills. This research, conducted under the guidance of an interdisciplinary team of mentors, will aid the PI in cultivating skills needed to advance as an independent scientist conducting clinical research optimizing symptoms to prevent chronic pain and prolonged opioid use postoperatively.

项目摘要 睡眠不足和睡眠不良在需要手术的肩部疾病患者中很普遍 干预 术前睡眠受损已被证明会诱发痛觉过敏，预测疼痛的发生， 发作，并导致更差的术后疼痛结局。考虑到急性疼痛的作用， 对慢性疼痛的影响， 缩短的睡眠和增加的睡眠障碍（例如，低效 睡眠）可能会有更大的风险发展为慢性术后疼痛。研究表明疼痛的效用 轨迹来预测慢性术后疼痛的发展，但缺乏研究检查 睡眠的变化如何导致慢性术后疼痛的发展，尽管有证据表明 睡眠影响疼痛。睡眠不佳可能导致慢性疼痛的一种途径是通过增加 全身性炎症睡眠时间缩短和睡眠障碍增加会诱发巨大的炎症反应， 反应，包括上调细胞因子，这使伤害性反应敏感，并可能增加 易患慢性术后疼痛。多达1/5的患者接受肩关节置换术 关节成形术需要长期阿片类药物治疗疼痛。到目前为止，术后阿片类药物的使用 主要使用患者自我报告或配药记录进行评估，对真实的 术后阿片类药物使用轨迹。这项前瞻性研究也试图阐明睡眠表现， 作为潜在的炎症变化，其催化肩关节成形术后急性疼痛向慢性疼痛的转变。 这将通过利用体动记录睡眠相关数据和收集的药物使用数据来实现 每天使用术前和术后参与者的电子监测，并将这些数据与 3个月后的生物心理社会结果和炎症标志物。本研究旨在描述和 通过活动记录仪对肩关节成形术前后的睡眠轨迹进行分类。此外，这项研究 将研究慢性术后疼痛的发展和真实的时间阿片类药物的使用，使用 药物事件监测系统（MEMS）帽，跨越睡眠轨迹。最后，本研究将比较 炎症标志物的纵向变化和随后的慢性疼痛的发展。这些研究 目标反映PI的职业发展目标，以发展细胞因子研究领域的专业知识， 在前瞻性研究中实施体动记录装置和MEMS，用于实时客观数据收集、分析 可视化纵向数据，并培养重要的领导技能。这项研究是在 一个跨学科的导师团队的指导，将有助于培养所需的技能，作为一个进步的PI 独立科学家进行临床研究，优化症状，以防止慢性疼痛和长期 术后使用阿片类药物。