Severe Pain During Wound Care Procedures: Model and Mechanisms

 描述(由申请人提供)：伤口护理程序，如换药，在74%的患者中会导致中度到重度疼痛，其中近一半(36%)患者经历严重疼痛(在10分数字评分标准中评级为8至10)。剧痛给病人和护士都带来了巨大的压力。不幸的是，WCPS期间剧烈疼痛的高发生率没有得到充分的认识和研究。到目前为止，预防WCPS期间疼痛的主要建议集中在预防性和程序性止痛或使用昂贵的非粘附性敷料上。然而，目前还不清楚哪些患者应该针对止痛或昂贵的敷料，从而导致他们不适当的过度或不足使用。在接受WCPS的患者中，只有23%的患者得到了止痛药，而可能减轻疼痛的敷料得到的更少。迫切需要能够预测哪些患者在WCPS期间可能出现严重疼痛，以便他们能够成为预防性疼痛控制策略的目标，包括使用阿片类止痛药和特殊敷料。这项研究的目标1是开发和评估一个预测WCPS期间剧烈疼痛的模型。尽管阿片类药物通常用于高度疼痛的情况，但它们可能不是控制开放伤口疼痛的最佳或足够的策略，因为它们损害伤口愈合，并可能导致伤口慢性化。阿片类药物的替代品极其有限，因为在WCPS期间导致伤害性敏感性和高度疼痛的生物机制尚不清楚。对这些机制的了解将指导新的有效干预措施的发展。目标2是确定这些机制。我们已经组建了一支特殊的多学科调查团队，以执行这项提案的目标。这些人包括具有以下专长的调查人员：慢性伤口临床研究(PI：Gardner)、临床(调查者：Rakel)和 基础科学(顾问：Brennan)疼痛研究、测量伤口生物负荷的基因组技术(调查者：Grice)和统计分析，包括接收器操作曲线(Statistician：Hillis)。为了达到研究的目的，在450名开放性伤口住院患者的样本中，将同时测量伤口、患者和生物因素的综合集合，同时测量换药时的疼痛。将开发一个预测模型，并将使用Logistic回归来检验生物机制。该模型将使用接收器操作员特性曲线进行评估。这项拟议的研究有可能做出重大贡献，因为临床医生将能够针对那些需要预防性疼痛控制的患者，从而消除痛苦程序对伤害性感受器敏化的螺旋式影响。此外，这些发现将为开发所需的、新的疼痛控制策略提供基础证据。积极的影响将是优化伤口护理，将疼痛和治疗的不利影响降至最低，并降低与伤口护理相关的成本。

 DESCRIPTION (provided by applicant): Wound care procedures, such as dressing changes, cause moderate to severe pain in 74% of patients, nearly half (36%) of whom experience severe pain (rated as 8 to 10 on a 10-point numeric rating scale). Severe pain causes substantial stress for both patient and nurse. Unfortunately, the high prevalence of severe pain during WCPs is under-recognized and under-studied. To date, mainstay recommendations to prevent pain during WCPs have focused on either administration of preventive and procedural analgesia or use of expensive, non-adherent dressings. However, it is unclear which patients to target for analgesia or expensive dressings, leading to their inappropriate over or under use. Analgesics are given to only 23% of patients undergoing WCPs and dressings that may decrease pain are given to even fewer. The ability to predict which patients are likely to have severe pain during WCPs is critically needed so that they can be targeted for preventive pain control strategies, including use of opioid analgesics and special dressings. Aim 1 of this study is to develop and evaluate a model to predict severe pain during WCPs. Although opioids are often given for highly painful conditions, they may not be an optimal or adequate strategy for controlling pain in open wounds because they impair wound healing and could lead to wound chronicity. The arsenal of alternatives to opioids is extremely limited because the biological mechanisms that contribute to nociceptive sensitivity and high pain during WCPs are unknown. Knowledge of these mechanisms would direct the development of new, effective interventions. Aim 2 is to identify these mechanisms. We have assembled an exceptional multi-disciplinary team of investigators to execute the aims of this proposal. These include investigators with expertise in: clinical research of chronic wounds (PI: Gardner), clinical (Investigator: Rakel) and basic science (Consultant: Brennan) research of pain, genomic technologies to measure wound bioburden (Investigator: Grice), and statistical analyses, including receiver operating curves (Statistician: Hillis). To achieve the aims of the study, a comprehensive set of wound, patient, and biological factors will be measured concurrently with pain during a dressing change among a sample of 450 inpatients with open wounds. A predictive model will be developed and biological mechanisms will be examined using logistic regression. The model will be evaluated using receiver operator characteristic curves. The proposed study has the potential to make significant contributions because clinicians will be able to target those patients requiring preventive pain control, thereby eliminating the spiraling impact of painful procedures on nociceptor sensitization. In addition, the findings will provide foundational evidence for the development of needed, novel pain control strategies. The positive impact will be to optimize wound care, minimize adverse effects of pain and treatment, and reduce the costs associated with wound care.