Prediction and Prevention of Persistent Post-Mastectomy Pain

乳房切除术后持续疼痛的预测和预防

• 批准号: 8995220
• 负责人: KRISTIN SCHREIBER
• 金额: $ 19.84万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-15 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8995220
• 关键词: Achievement; Affect; Animal Model; Anxiety; Biometry; Cancer Center; Characteristics; Chronic; Clinical; Clinical Trials; Data; Detection; Development; Doctor of Philosophy; Effectiveness of Interventions; Enrollment; Future; Health; Health Personnel; High Risk Woman; Individual; Individual Differences; Intervention Trial; Investigation; Ketamine; Mastectomy; Medical; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Modeling; Nature; Nociception; Noise; Operative Surgical Procedures; Pain; Pain Threshold; Patient risk; Patients; Perioperative; Persons; Pharmaceutical Preparations; Pharmacy (field); Physiology; Placebos; Play; Postoperative Pain; Pre-Clinical Model; Preemptive Analgesia; Prevention; Preventive; Preventive Intervention; Preventive treatment; Process; Process Measure; Prospective Studies; Psychology; Psychophysics; Psychosocial Factor; Radiation therapy; Research Infrastructure; Research Personnel; Retrospective Studies; Risk; Risk Factors; Role; Sensory; Signal Transduction; Sleep disturbances; Societies; Stimulus; Syndrome; Testing; Therapeutic Trials; Training; Translations; Treatment Factor; Woman; Work; aging population; base; career; career development; chemotherapy; chronic pain; cohort; cost; design; high risk; improved; indexing; malignant breast neoplasm; negative affect; novel; novel therapeutics; pre-clinical; pressure; prevent; psychologic; psychosocial; screening; skills; statistics; success; surgical pain; therapeutic effectiveness; tool

DESCRIPTION (provided by applicant): Chronic pain is devastating both to individuals and society. In an aging population, surgery is an increasing cause of chronic pain, with rates of persistent post-operative pain ranging from 10-65%. In particular, Persistent Post-Mastectomy Pain (PPMP) occurs in roughly one third of women who have had mastectomy. The occurrence of PPMP does not seem to be strongly determined by the type of surgery, chemotherapy, and radiation treatment, suggesting that individual person-specific factors may play a more important role. In fact, recent studies by the candidate indicate that individual differences in pain sensitiity (psychophysics) are more closely associated with PPMP than surgical/medical variables. Specifically, sensory testing revealed that women who developed PPMP had lower pressure pain thresholds and greater temporal summation of pain stimuli than women who did not develop this chronic pain condition. Moreover, psychosocial factors such as anxiety, depression, catastrophizing, and somatization were more prominent in women with PPMP. These preliminary, retrospective studies suggest that individual psychophysical and psychosocial characteristics could be important risk factors for PPMP. Accordingly, the first Aim of this study is to comprehensively and prospectively study women having mastectomy surgery, to determine the relationship between pre-operative psychophysical and psychosocial factors and the development of PPMP. The second Aim is to develop a prediction model for PPMP using the data collected in Aim 1, thus allowing a preoperative calculation of a "PPMP risk score" for any patient facing mastectomy. This will then be validated in a separate group of patients (study 2). Study will be this risk score will be used to enrich an interventional trial with a greater proporton of women at high risk of PPMP, with Aim 3 to investigate whether this enrichment allows more efficient and sensitive determination of a preventative drug's effect than in an unscreened group. These studies will lay the groundwork to efficiently test novel pharmaceutics only in the high risk patients who need them. The candidate in this application, Dr. Kristin Schreiber is a PhD-trained Neuroscientist and Anesthesiologist at a leading academic, high-volume breast cancer center. The proposed studies would inform healthcare providers about the underlying mechanisms contributing to chronic pain after surgery, thus allowing more targeted, preventive treatment in patients who are high risk for persisting post-operative pain. Her career development mentors are experts in surgical, medical, psychological, and preoperative assessment, preclinical modeling, and biostatistics. The candidate's strong scientific background, taken together with the proposed formal training in advanced statistics and diverse mentorship, in a center that has a strong tradition and infrastructure for clinical trials, will enure the successful achievement of her scientific and career objectives to prevent PPMP and lay the groundwork for prevention of other persistent post-surgical pain syndromes.

描述（由申请人提供）：慢性疼痛对个人和社会都造成了破坏。在老龄化的人口中，手术是慢性疼痛的越来越多的原因，持续的术后疼痛率为10-65％。特别是，在乳房切除术的女性中，大约三分之一的女性发生了持续的术后疼痛（PPMP）。 PPMP的发生似乎并未通过手术，化学疗法和放射治疗的类型明确确定，这表明个人特异性因素可能起着更重要的作用。实际上，候选人最近的研究表明，疼痛敏感性（心理物理学）的个体差异与PPMP相比，与手术/医疗变量更紧密相关。具体而言，感官测试表明，与未发展这种慢性疼痛状况的女性相比，患有PPMP的女性的压力阈值较低，疼痛刺激的时间刺激更大。此外，在PPMP女性中，诸如焦虑，抑郁，灾难性和躯体化之类的社会心理因素更为突出。这些初步的回顾性研究表明，个体的心理物理和社会心理特征可能是PPMP的重要危险因素。因此，这项研究的第一个目的是全面和前瞻性地研究接受乳房切除术手术的女性，以确定术前心理物理和心理社会因素与PPMP的发展之间的关系。第二个目的是使用AIM 1中收集的数据开发PPMP的预测模型，从而为任何面临乳房切除术的患者进行术前计算“ PPMP风险评分”。然后将在单独的一组患者中进行验证（研究2）。研究将是这种风险评分将用于丰富一项介入的试验，其比例更高，具有PPMP高风险的女性，AIM 3来研究这种富集是否允许对预防性药物的效应更有效，更敏感地确定比未经筛查的组更高。这些研究将为仅在需要它们的高风险患者中有效测试新型药物的基础。在此应用程序中，克里斯汀·施雷伯（Kristin Schreiber）博士是一位受过博士学位培训的神经科学家和麻醉师，是一位领先的高知识乳腺癌中心。拟议的研究将为医疗保健提供者提供有关导致慢性疼痛的潜在机制，从而使对持续术后疼痛的高风险的患者更具针对性的预防性治疗。她的职业发展导师是手术，医学，心理和术前评估，临床前建模和生物统计学的专家。候选人的强大科学背景与拟议的高级统计和不同指导方面的正式培训一起，在一个具有强大的传统和基础设施的中心，将促进其成功实现其科学和职业目标，以防止PPMP预防其他持久性后表面性止痛综合症的洞察力。