Predicting severe post-surgical pain using clinical risk factors

描述（由申请人提供）：术后期间疼痛未缓解仍然是一个重大挑战。令人震惊的是，25%的外科手术患者，或每年约1500万美国外科手术患者，在术后即刻经历严重的急性疼痛（定义为在口头评定量表上10分之7的疼痛）。严重的术后疼痛与严重的术后并发症有关，是延迟出院和意外再入院的最常见原因。事实上，每年至少有10亿美元的医疗保健费用归因于对不受控制的术后疼痛的直接支出。此外，管理不善的急性术后疼痛具有深远和长期的后果，因为它与慢性疼痛的发展有关。一个系统构建的疼痛预测模型和临床风险评分，就像那些为其他多因素原因的疾病（如术后恶心和呕吐、心血管疾病和癌症）开发的模型和评分一样，可以为临床医生提供机会，采用更积极主动和个性化的方法来进行术后疼痛管理，并防止患者现在和将来遭受过度痛苦。 本研究将使用多变量分析来评价严重术后疼痛的临床风险因素，然后开发并验证临床风险评分，该评分将允许临床医生密切监测并为高风险患者提供量身定制的预防性疼痛管理。在具体目标1中，我们将通过对从12个美国医疗中心前瞻性收集的1，700名成人门诊手术患者的疼痛数据进行一系列数据分析，确定关键的独立预测因素，并制定严重术后疼痛的风险评分。在特定目标2中，我们将通过评价风险评分预测严重术后疼痛的区分力来验证风险评分，该风险评分应用于1）456例门诊手术患者和2）2,000例成人手术住院患者的围手术期数据。 这项研究将为临床医生提供一个实用的工具，根据患者的严重术后疼痛风险状况对患者进行分层，并相应地促进个性化疼痛管理。它还将提供对严重疼痛的关键临床风险因素的洞察力，并确定那些可以避免或由临床医生修改的风险因素。此外，该R 03提案将能够开发和测试用于预防和治疗严重术后疼痛的新型治疗方法，并旨在为一系列临床相关和范式转变的R 01拨款提案奠定基础。 公共卫生相关性：未缓解的严重术后疼痛影响了25%的美国手术患者，造成不必要的患者痛苦，每年花费美国医疗保健系统近10亿美元，并可能导致慢性术后疼痛的发展。我们将开发一种临床适用的严重术后疼痛预测模型，这将有助于早期识别高风险患者进行更密切的监测，并为临床医生提供机会，采用更积极主动和个性化的方法来进行术后疼痛管理。从这项研究中获得的关于急性术后疼痛的见解将使临床医生能够解决可改变的风险因素，并指导新型疼痛疗法的开发，以实现更好，更个性化的患者护理。

DESCRIPTION (provided by applicant): Unrelieved pain remains a significant challenge during the postoperative period. A staggering 25% of surgical patients, or about 15 million U.S. surgical patients annually, experience severe acute pain (defined as pain e 7 out of 10 on a Verbal Rating Scale) in the immediate postoperative period. Severe post-surgical pain is associated with serious post-surgical complications and is the most common cause of delayed hospital discharge and unanticipated readmission. In fact, at least $1 billion annually in health care costs is attributed to direct spending on uncontrolled post-surgical pain. Furthermore, poorly managed acute post-surgical pain has far-reaching and long-term consequences as it has been associated with the development of chronic pain. A systematically constructed predictive model and clinical risk score for pain, like those developed for other conditions with multi-factorial causes such as postoperative nausea and vomiting, cardiovascular diseases, and cancer, could afford clinicians the opportunity to adopt a more proactive and personalized approach to post-surgical pain management and preclude patients from unduly suffering both now and in the future. This study will use multivariable analysis to evaluate clinical risk factors for severe post-surgical pain, and then develop and validate a clinical risk score that will allow clinicians to closely monitor and provide tailored prophylactic pain management to high- risk patients. In Specific Aim 1 we will identify the key independent predictors and develop a risk score for severe post-surgical pain by performing a series of data analysis on pain data prospectively collected from 1,700 adult ambulatory surgery patients from 12 US medical centers. In Specific Aim 2 we will validate the risk score by evaluating its discriminating power to predict severe post-surgical pain when applied to perioperative data from 1) 456 ambulatory surgery patients and 2) 2,000 adult surgical in-patients. This study will provide clinicians with a practical tool to stratify patients according their risk profile for severe post-surgical pain and facilitate personalized pain management accordingly. It will also provide insight into key clinical risk factors for severe pain and pinpoint those that can be avoided or modified by the clinician. Furthermore, this R03 proposal will enable the development and testing of novel treatments for preventing and treating severe post-surgical pain and is designed to build a foundation for a series clinically relevant and paradigm-shifting R01 grant proposals. PUBLIC HEALTH RELEVANCE: Unrelieved severe post-surgical pain affects a staggering 25% of U.S. surgical patients, causes unnecessary patient suffering, costs the U.S. healthcare system close to $1 billion annually, and may contribute to the development of chronic post-surgical pain. We will develop a clinically applicable predictive model for severe post-surgical pain that will facilitate early identification of high-risk patients for closer monitoring and afford clinicians the opportunity to adopt a more proactive and personalized approach to post-surgical pain management. Insights gained from this study on acute post-surgical pain will allow clinicians to address modifiable risk factors and direct the development of novel pain therapies towards better, more individualized patient care.