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，其中约一半经历中度至重度手术后疼痛。有些儿童的疼痛也可能持续到术后不久，并转变为慢性疼痛。然而，关于儿科手术人群中持续术后疼痛的患病率或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知之甚少。了解可能预测儿童经历持续术后疼痛和降低HRQOL风险的生物心理社会因素将解决知识空白，以便将来开发预防性干预措施。本应用程序的目的是记录手术后儿童疼痛和HRQOL的纵向轨迹，并确定使儿童处于急性和慢性手术后疼痛和HRQOL恶化风险的个体差异。本研究的长期目标是制定有效的策略来预防儿童术后持续疼痛。K23候选人是华盛顿大学麻醉学和疼痛医学系的助理教授，西雅图儿童医院的儿科麻醉师和疼痛医生。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。候选人表现出以患者为导向的研究生涯的承诺，并提出了一个五年的培训计划，在教师导师的支持下，他们在儿科疼痛、健康服务结果研究、儿科研究伦理和生物统计学方面具有专业知识。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，预防研究和研究生涯发展指导的专业指导。研究计划包括两项研究。研究1将前瞻性地监测手术前后的疼痛和HRQOL，在一个大型医院队列中，在出院后的第一个月内接受小手术和大手术的儿童。研究2将前瞻性地测量个体差异（临床和生物心理社会因素）与大手术前和术后18个月以上疼痛和功能变化相关的样本，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。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，确保了所提出研究的成功开展。这项研究产生的数据将用于确定有慢性术后疼痛和生活质量受损风险的儿童，并将指导以后的研究，为有风险的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.