Pain and Health-Related Quality of Life in Children after Surgery

描述(由申请人提供)：在美国，每年有超过450万儿童接受手术，其中约一半经历手术后的中到重度疼痛。对于一些儿童来说，疼痛也可能持续到手术后的即刻，并过渡到慢性疼痛。然而，关于儿科手术人群中持续性疼痛的流行情况，以及疼痛对儿童身体功能、健康相关生活质量(HRQOL)和卫生服务利用的影响，人们知之甚少。了解可能预测儿童术后持续性疼痛和HRQOL降低的风险的生物、心理和社会因素将解决知识差距，以便将来制定预防干预措施。该应用程序的目的是记录儿童手术后疼痛和HRQOL的纵向轨迹，并确定将儿童置于手术后急性和慢性疼痛和HRQOL恶化风险中的个体差异。这项研究的长期目标是开发有效的策略来预防儿童术后持续性疼痛。这位K23候选人是华盛顿大学麻醉学和疼痛医学系的助理教授，也是西雅图儿童医院的儿科麻醉师和疼痛内科医生。她的K23提案将利用华盛顿大学医学院和西雅图儿童研究所的丰富资源。这位候选人表现出了对以患者为中心的研究生涯的承诺，并在拥有儿科疼痛、卫生服务结果研究、儿科研究伦理和生物统计学专业知识的教师导师的支持下提出了一项五年培训计划。通过研究培训计划，候选人将获得最先进的疼痛和功能结果评估工具、干预研究方法、预防研究和研究职业发展指导方面的专门指导。研究计划涉及两项研究。研究1将前瞻性地监测在出院后第一个月内接受小手术和大手术的大型医院队列儿童手术前后的疼痛和HRQOL。研究2将使用最先进的测量工具，包括每日电子日记监测和动态活动记录仪，前瞻性地测量与大手术前和18个月后疼痛和功能变化相关的个体差异(临床和生物心理社会因素)，在一个较小的、具有良好特征的样本中进行。初步数据证明了围手术期和术后多方法评估计划的可行性，并确保了拟议研究的成功实施。这项研究产生的数据将用于识别手术后慢性疼痛和生活质量受损的高危儿童，并将指导以后的研究，为高危青少年开发和测试医疗和行为干预措施。完成拟议的研究和培训计划将为候选人提供必要的数据和基本技能，以发展成为一名成功的独立儿科疼痛研究人员。

DESCRIPTION (provided by applicant): Over 4.5 million children undergo surgery in the U.S. each year and about half of them experience moderate- severe postsurgical pain. Pain may also persist beyond the immediate postsurgical period and transition into chronic pain for some children. However, little is known about the prevalence of persistent postsurgical pain in the pediatric surgery population or of the impact of pain on children's physical functioning, health-related quality of life (HRQOL) and health service utilization. Understanding of the biopsychosocial factors that may predict a child's risk for experiencing persistent postsurgical pain and reduced HRQOL would address gaps in knowledge to allow for the future development of preventive interventions. The objective of this application is to document longitudinal trajectories of pain and HRQOL in children following surgery, and to identify individual differences that place children at risk for both acute and chronic postsurgical pain and deteriorations in HRQOL. The long-term goal of this research is to develop effective strategies to prevent persistent postsurgical pain in children. The K23 candidate is an assistant professor in the Department of Anesthesiology and Pain Medicine at the University of Washington and a pediatric anesthesiologist and pain physician at Seattle Children's Hospital. Her K23 proposal will capitalize on the wealth of resources available at the University of Washington School of Medicine and Seattle Children's Research Institute. The candidate has demonstrated commitment to a patient-oriented research career and proposes a five-year training plan with the support of faculty mentors who have expertise in pediatric pain, health services outcomes research, pediatric research ethics, and biostatistics. Through the research training plan the candidate will obtain specialized instruction in state-of-the-art pain and functional outcomes assessment tools, intervention research methodology, preventive research and mentorship in research career development. The research plan involves two studies. Study 1 will prospectively monitor pain and HRQOL before and after surgery in a large hospital-based cohort of children undergoing minor and major surgical procedures over the first month post-hospital discharge. Study 2 will prospectively measure individual differences (clinical and biopsychosocial factors) associated with change in pain and function before and over 18 months following major surgery in a smaller, well-characterized sample using state-of-the art measurement tools including daily electronic diary monitoring and ambulatory actigraphy. Preliminary data demonstrate the feasibility of the multi-method assessment plan in the perioperative and postoperative periods and ensure success in carrying out the proposed studies. Data generated from this research will be used to identify children at-risk for chronic postsurgical pain and impaired quality of life, an will guide later research to develop and test medical and behavioral interventions for at-risk youth. Completion of the proposed research and training plan will provide the candidate with necessary data and essential skills to develop into a successful independent pediatric pain researcher.