Nonpharmacological Strategies to Mitigate Pain and Problematic Opioid Use After Spine Surgery

项目总结/摘要 背景：疼痛和阿片类药物使用问题在脊柱手术后的几个月内很常见。的目标 博士约翰·马格尔的NCATS/NCCIH KL 2行政补充奖是为了获得必要的培训， 实践经验和知识，是一个领先的独立调查员谁专注于康复， 改善慢性精神分裂症患者的结局并减轻有问题的处方阿片类药物使用（PPOU） 肌肉骨骼疾病他提议的职业发展奖旨在支持这一转变。他 将使用前瞻性和定性方法来确定适应不良信念（疼痛- 灾难化、运动恐惧症和疼痛自我效能）影响阿片类药物的使用， 是否有机会为改善疼痛和减少阿片类药物的消耗量身定制康复， 有PPOU风险的患者。 研究设计和方法：一个前瞻性的脊柱手术患者队列， 确定适应不良疼痛信念与未来阿片类药物使用和身体状况的结果之间的关联 PPOU风险患者的功能。在一个单独的脊柱手术患者队列中， 访谈将用于评估患者对术后非药物治疗的看法， 物理治疗师进行的干预。目的1：在有PPOU风险的患者中，确定 脊柱手术后测量阿片类药物使用和身体功能的适应不良疼痛信念。阿片类药物使用和 脊柱手术后3-6个月的身体功能， 将对PPOU进行评价。适应不良的疼痛信念（疼痛灾难化， 运动恐惧症和疼痛自我效能）对（1a）阿片类药物使用和（1b）身体功能的影响，同时控制 协变量（例如，将评估PT出勤率、患者人口统计学资料、合并症、手术类型）。目标二： 使用以下方法确定患者对非药物术后疼痛管理策略的看法： 脊柱手术后服用阿片类药物将采用半结构化的深入访谈来确定主题 描述了他们对非药物术后疼痛管理的看法。 职业发展计划：KL 2职业发展奖解决了我目前的这些差距 研究能力：1）发展阿片类药物风险评估和风险缓解方面的专业知识，2）发展 设计和进行临床试验，以及卫生系统研究的定性和混合方法 3)培养独立领导和管理研究项目的能力。这些弱点将得到解决。 利用犹他州大学强大的KL 2项目提供的资源， 推荐的课程和实践培训，以及与国际公认的团队互动， 专家导师和顾问。

PROJECT SUMMARY/ABSTRACT Background: Pain and problematic opioid use is common in the months following spine surgery. The goal for Dr. John Magel's NCATS/NCCIH KL2 Administrative Supplemental Award is to acquire the necessary training, practical experience, and knowledge to be a leading independent investigator who focuses on rehabilitation to improve outcomes and mitigate problematic prescription opioid use (PPOU) in patients with chronic musculoskeletal conditions. His proposed career development award is designed to support this transition. He will use prospective and qualitative methodologies to determine the extent to which maladaptive beliefs (pain- catastrophizing, kinesiophobia, and pain self-efficacy) measured after spine surgery impacts opioid use and whether opportunities exist to tailor rehabilitation toward improving pain and reducing opioid consumption in patients at risk for PPOU. Research Design and Methods: A prospective cohort of patients who had spine surgery will be used to determine associations between maladaptive pain beliefs and the outcomes of future opioid use and physical function in patients at risk PPOU. In a separate cohort of patients who had spine surgery, semi-structured interviews will be used to evaluate the perceptions of patients related to post-surgical nonpharmacologic interventions performed by physical therapists. Aim 1: In patients at risk for PPOU, determine the impact of maladaptive pain beliefs measured after spinal surgery on opioid use and physical functioning. Opioid use and physical function during the 3-6 month postoperative period in patients after spine surgery who are at risk for PPOU will be evaluated. The association between maladaptive pain beliefs (pain catastrophizing, kinesiophobia, and pain self-efficacy) on (1a) opioid use and (1b) physical function while controlling for covariates (e.g., attendance in PT, patient demographics, comorbidities, surgical type) will be assessed. Aim 2: Determine the perceptions of nonpharmacologic postoperative pain management strategies in patients using prescription opioids after spine surgery. Semi-structured, in-depth interviews will be used to identify themes among the patients that describe their perceptions of nonpharmacologic postoperative pain management. Career Development Plan: The KL2 Career Development Award with address these gaps in my current research abilities: 1) develop expertise in opioid risk assessment and risk mitigation, 2) develop skills in designing and conducting clinical trials and in and qualitative and mixed methods for health systems research 3) cultivate skills to independently lead and manage a research program. These weaknesses will be addressed using the resources the resources provided by the university of Utah's robust KL2 program and through recommended courses and hands-on training as well as interacting with an international recognized team of expert mentors and advisors.