Biopsychosocial Influence on Shoulder Pain

摘要 针对特定患者特征的治疗（即精准医疗）有可能提供更多 术后疼痛管理的有效选择。慢性疼痛状况是社会的沉重负担 由于其经济影响和个人痛苦，他们造成的;和发展精准医疗方法 是联邦疼痛研究战略的重点因此，在本提案中，我们将发起一项 全肩关节置换术的精确医学方法，通过识别可预测 慢性术后疼痛生物、心理和社会因素（单独和组合）将是 被认为是风险表型的候选者。此外，生化生物标志物和 心理因素将被视为术后时变因素，以提高预测准确性 的风险表型。该提案将支持一项前瞻性队列研究，该研究包括461名接受 在杜克健康中心接受初次全肩关节置换术（解剖型或反向型）。主要结局是慢性术后 全肩关节置换术后12个月的手术疼痛。风险表型指标将在 将在术前和术后收集手术和随时间变化的因素。我们将调查 确定慢性术后疼痛风险的生物学、心理学和社会因素的新组合 全肩关节置换术的表型。此外，将测试随时间变化的因素，以改善 风险表型的预测准确性。该提案将通过解决以下问题来推进疼痛研究领域 成年骨关节炎患者术后慢性疼痛发展的重要知识差距， 经历a）体积快速增加和B）具有高术后风险的外科手术 痛苦研究的成功完成有可能改变手术选择的护理标准， 为术后疼痛管理提供了新的精准医疗途径。具体而言，完成 这项研究可能允许风险分层的方法，改善手术决策的实施 在卫生保健系统和/或确定新的治疗目标，可以测试的有效性， 预防术后慢性疼痛。

Abstract Treatment tailored to specific patient characteristics (i.e. precision medicine) has the potential to offer more effective options for post-operative pain management. Chronic pain conditions are a heavy burden to society due their economic impact and individual suffering they cause; and developing precision medicine approaches are a high priority for the Federal Pain Research Strategy. Accordingly, in this proposal, we will initiate a precision medicine approach for total shoulder arthroplasty by identifying a risk phenotype that is predictive of chronic post-surgical pain. Biologic, psychologic, and social factors (alone and in combination) will be considered as candidates for the risk phenotype. Additionally, changes in biochemical biomarkers and psychologic factors will be considered as post-operative time-varying factors to enhance predictive accuracy of the risk phenotype. This proposal will support a prospective cohort study of 461 individuals undergoing primary total shoulder arthroplasty (anatomic or reverse) at Duke Health. The primary outcome is chronic post- surgical pain 12-months after total shoulder arthroplasty. Risk phenotype measures will be collected pre- operatively and time-varying factors will be collected pre-operatively and post-operatively. We will investigate novel combinations of biologic, psychologic, and social factors to determine a chronic post-surgical pain risk phenotype for total shoulder arthroplasty. Additionally, time-varying factors will be tested for improving predictive accuracy of the risk phenotype. This proposal will advance the pain research field by addressing important knowledge gaps in chronic post-surgical pain development for adults with osteoarthritis that are undergoing a surgical procedure that is a) rapidly increasing in volume and b) has a high risk of post-operative pain. Successful completion of the study has the potential to alter standard of care for surgical selection and provide new avenues of precision medicine for post-operative pain management. Specifically, completion of this study may allow for risk stratification approaches that improve surgical decision making to be implemented in health care systems and/or identify novel treatment targets that could be tested for effectiveness in preventing chronic post-surgical pain.