Biobehavioral Risk Factors for Persistent Pain following Total Knee Arthroplasty

描述（由申请人提供）：退行性关节疾病，特别是膝骨关节炎（OA），是最普遍和致残的慢性疼痛疾病之一，预计随着美国人口老龄化，该疾病将急剧增加。预测还表明，在未来几十年里，美国每年的全膝关节置换术（终末期膝关节OA的治疗选择）数量将增加5到10倍。虽然全膝关节置换术后的结果通常是良好的，但仍有相当一部分患者在手术后继续经历严重的长期疼痛和残疾。膝关节置换术后疼痛和功能的个体差异与体格检查和影像学检查结果的关系很小。我们的小组已经确定了几个潜在的重要变量，这些变量可能在形成长期疼痛结果中发挥作用，尽管很少有关于膝关节OA患者的已发表的研究。拟议的2点前瞻性队列项目将仔细评估和跟踪接受全膝关节置换术的患者样本。膝关节炎患者术前将接受一系列心理物理疼痛测试程序、睡眠质量、连续性和结构的多模式评估、心理功能问卷调查和生理采样（如血液和唾液样本）。通过12个月的随访评估疼痛、功能和止痛药使用等结果。这些数据将使我们能够对这些类别的“风险因素”变量的独特和综合影响进行建模。总的来说，识别与关节置换术后持续疼痛和疼痛相关残疾的发展和维持相关的因素对手术患者的选择和术后疼痛的处理具有重要的实际意义，同时对理解疼痛相关结果的个体差异的来源也具有理论意义。

DESCRIPTION (provided by applicant): Degenerative joint disease, particularly knee osteoarthritis (OA), is one of the most prevalent and disabling chronic pain conditions and is projected to increase sharply as the U.S. population ages. Projections also indicate that the annual number of total knee replacements, the treatment of choice for end-stage knee OA, will increase five- to ten-fold in the U.S. over the next several decades. While the outcomes following total knee arthroplasty are generally good, a substantial minority of patients continue to experience significant long-term pain and disability after surgery. These individual differences in the trajectory of pain and function after knee replacement are minimally related to findings from physical examination and imaging procedures. Our group has identified several potentially important variables that are likely to play a role in shaping long-term pain outcomes, though there are few published studies in patients with knee OA. The proposed 2-site prospective cohort project will carefully evaluate and follow a sample of patients undergoing total knee replacement. Knee OA patients will be assessed pre-surgically with a battery of psychophysical pain testing procedures, multimodal evaluation of sleep quality, continuity, and architecture, questionnaires regarding psychological function, and physiological sampling (e.g., blood and saliva samples). Outcomes such as pain, functioning, and analgesic usage will be evaluated through 12-month follow-up. These data will allow us to model the unique and combined impact of these classes of "risk factor" variables. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for selection of surgical patients and for management of post-operative pain, as well as theoretical importance in understanding the sources of individual differences in pain-related outcomes. PUBLIC HEALTH RELEVANCE: Chronic pain is a critical national and international health problem, making the identification of groups at high risk for the development or persistence of chronic pain an increasingly important area of investigation. This project seeks to identify risk factors for persistent pain and physical disability following total knee replacement, a surgical procedure projected to increase five- to ten-fold in the U.S. over the next several decades. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for the selection of surgical patients, for the management of post-operative pain, and for understanding the sources of individual differences in pain-related outcomes.