Predicting severe post-surgical pain using clinical risk factors

描述（由申请人提供）：术后未缓解的疼痛仍然是一个重大挑战。令人震惊的是，25%的手术患者，或每年约1500万美国手术患者，在术后立即经历严重的急性疼痛（定义为疼痛在口头评定量表上为10分中的7分）。严重的术后疼痛与严重的术后并发症相关，是延迟出院和意外再入院的最常见原因。事实上，每年至少有10亿美元的医疗费用是直接用于治疗无法控制的术后疼痛。此外，处理不当的急性术后疼痛具有深远和长期的后果，因为它与慢性疼痛的发展有关。系统构建的疼痛预测模型和临床风险评分，就像为其他多因素原因（如术后恶心和呕吐、心血管疾病和癌症）开发的预测模型和临床风险评分一样，可以使临床医生有机会采取更主动和个性化的方法来进行术后疼痛管理，并防止患者现在和将来过度痛苦。本研究将使用多变量分析来评估严重术后疼痛的临床危险因素，然后开发和验证临床风险评分，使临床医生能够密切监测并为高危患者提供量身定制的预防性疼痛管理。在具体目标1中，我们将通过对来自12个美国医疗中心的1700名成人门诊手术患者的前瞻性疼痛数据进行一系列数据分析，确定关键的独立预测因素，并制定严重术后疼痛的风险评分。在具体目标2中，我们将通过评估风险评分预测严重术后疼痛的判别能力来验证风险评分，并将其应用于来自1)456名门诊手术患者和2)2000名成年外科住院患者的围手术期数据。本研究将为临床医生提供一种实用的工具，根据患者的术后严重疼痛风险概况对患者进行分层，并相应地促进个性化疼痛管理。它还将提供对严重疼痛的关键临床风险因素的见解，并指出那些可以被临床医生避免或修改的因素。此外，该R03提案将促进预防和治疗严重术后疼痛的新疗法的开发和测试，并旨在为一系列临床相关和范式转变的R01拨款提案奠定基础。

DESCRIPTION (provided by applicant): Unrelieved pain remains a significant challenge during the postoperative period. A staggering 25% of surgical patients, or about 15 million U.S. surgical patients annually, experience severe acute pain (defined as pain e 7 out of 10 on a Verbal Rating Scale) in the immediate postoperative period. Severe post-surgical pain is associated with serious post-surgical complications and is the most common cause of delayed hospital discharge and unanticipated readmission. In fact, at least $1 billion annually in health care costs is attributed to direct spending on uncontrolled post-surgical pain. Furthermore, poorly managed acute post-surgical pain has far-reaching and long-term consequences as it has been associated with the development of chronic pain. A systematically constructed predictive model and clinical risk score for pain, like those developed for other conditions with multi-factorial causes such as postoperative nausea and vomiting, cardiovascular diseases, and cancer, could afford clinicians the opportunity to adopt a more proactive and personalized approach to post-surgical pain management and preclude patients from unduly suffering both now and in the future. This study will use multivariable analysis to evaluate clinical risk factors for severe post-surgical pain, and then develop and validate a clinical risk score that will allow clinicians to closely monitor and provide tailored prophylactic pain management to high- risk patients. In Specific Aim 1 we will identify the key independent predictors and develop a risk score for severe post-surgical pain by performing a series of data analysis on pain data prospectively collected from 1,700 adult ambulatory surgery patients from 12 US medical centers. In Specific Aim 2 we will validate the risk score by evaluating its discriminating power to predict severe post-surgical pain when applied to perioperative data from 1) 456 ambulatory surgery patients and 2) 2,000 adult surgical in-patients. This study will provide clinicians with a practical tool to stratify patients according their risk profile for severe post-surgical pain and facilitate personalized pain management accordingly. It will also provide insight into key clinical risk factors for severe pain and pinpoint those that can be avoided or modified by the clinician. Furthermore, this R03 proposal will enable the development and testing of novel treatments for preventing and treating severe post-surgical pain and is designed to build a foundation for a series clinically relevant and paradigm-shifting R01 grant proposals. PUBLIC HEALTH RELEVANCE: Unrelieved severe post-surgical pain affects a staggering 25% of U.S. surgical patients, causes unnecessary patient suffering, costs the U.S. healthcare system close to $1 billion annually, and may contribute to the development of chronic post-surgical pain. We will develop a clinically applicable predictive model for severe post-surgical pain that will facilitate early identification of high-risk patients for closer monitoring and afford clinicians the opportunity to adopt a more proactive and personalized approach to post-surgical pain management. Insights gained from this study on acute post-surgical pain will allow clinicians to address modifiable risk factors and direct the development of novel pain therapies towards better, more individualized patient care.