Differential Susceptibility for Developing Chronic Post-Surgical Pain Across Sleep Trajectories and Inflammatory Presentations

项目总结 睡眠不足和睡眠不佳在需要手术的肩部疾病患者中普遍存在 干预。 术前睡眠受损已被证明会导致痛觉过敏，预示疼痛的发生 发作，并导致更糟糕的术后疼痛结果。考虑到不受控制的急性疼痛的贡献作用 已发展为慢性疼痛的S患者 睡眠时间缩短和睡眠干扰增加(例如，效率低下 睡眠)可能发生慢性手术后疼痛的风险更大。研究表明疼痛的效用 预测慢性手术后疼痛发展的轨迹，但缺乏研究检验 尽管有证据表明，睡眠变化如何促进手术后慢性疼痛的发展 睡眠会影响疼痛。睡眠不佳可能导致慢性疼痛的一个途径是通过增加 全身炎症。睡眠时间缩短和睡眠障碍增加会导致超大炎症 反应，包括上调细胞因子，使伤害性反应敏感，并可能增加 易发展为慢性手术后疼痛。多达五分之一的患者接受肩部手术 关节成形术需要长时间的阿片类药物治疗来控制疼痛。到目前为止，术后阿片类药物的使用 主要使用患者自我报告或配药记录进行评估，很少有人知道真正的- 术后时间阿片类药物使用轨迹。这项前瞻性研究也试图阐明睡眠表现。 由于潜在的炎症变化，这催化了肩关节置换术后从急性到慢性的疼痛过渡。 这将通过利用与睡眠相关的动作记录数据和收集的药物利用数据来实现 每天使用参与者在手术前和手术后的电子监测，并将这些数据与 3个月后的生物心理社会结局和炎症标志物。这项研究旨在描述和描述 通过活动记录仪对肩关节置换手术前后的睡眠轨迹进行分类。此外，这项研究 将检查慢性手术后疼痛的发展和实时阿片类药物的使用，捕获使用 药物事件监测系统(MEMS)帽，跨越睡眠轨迹。最后，本研究将比较 炎症标志物的纵向变化和随后的慢性疼痛的发展。这些研究 目标反映了专业人员的职业发展目标，即培养细胞因子研究领域的专门知识， 将运动成像设备和MEMS应用到前瞻性研究中，以实时收集、分析目标数据 并将纵向数据可视化，并培养至关重要的领导技能。这项研究是在 在跨学科导师团队的指导下，将帮助PI培养作为一名 独立科学家进行临床研究，优化症状以预防慢性疼痛和延长 术后使用阿片类药物。

PROJECT SUMMARY Insufficient and poor sleep is pervasive among individuals with shoulder conditions requiring surgical intervention. Impaired preoperative sleep has been shown to induce hyperalgesia, predict the onset of painful episodes, and result in worse postoperative pain outcomes. Given the contributing role unmanaged acute pain has on developing chronic pain, patients with s hortened sleep and increased sleep disturbances (e.g., inefficient sleep) may be at greater risk for developing chronic post-surgical pain. Research shows the utility of pain trajectories to predict the development of chronic post-surgical pain, yet there is a dearth of research examining how changes in sleep contribute to the development of chronic post-surgical pain, despite evidence showing sleep impacts pain. One pathway through which poor sleep may contribute to chronic pain is through increased systemic inflammation. Shortened sleep and increased sleep disturbances induce an outsized inflammatory reaction, including upregulating cytokines, which sensitizes the nociceptive response and may increase susceptibility for developing chronic post-surgical pain. As many as 1 in 5 patients undergoing shoulder arthroplasty require prolonged opioid therapy for pain management. To date, postoperative opioid utilization has been assessed predominantly using patient self-report or dispensing records, with little known regarding real- time postoperative opioid use trajectories. This prospective study seeks to elucidate sleep presentations, as well as underlying inflammatory changes, that catalyze the acute to chronic pain transition after shoulder arthroplasty. This will be accomplished by leveraging actigraphy sleep-related data and medication utilization data collected daily using electronic monitoring from participants pre- and postoperatively and pairing those data with biopsychosocial outcomes and inflammatory markers up to 3-months later. This study aims to characterize and classify sleep trajectories prior to and after shoulder arthroplasty via actigraphy devices. Additionally, this study will examine the development of chronic post-surgical pain and real time opioid utilization, captured using Medication Event Monitoring Systems (MEMS) caps, across sleep trajectories. Finally, this study will compare longitudinal changes in inflammatory markers and subsequent development of chronic pain. These research aims reflect the PI’s career development objectives to develop expertise in the areas of cytokine research, implement actigraphy devices and MEMS into prospective studies for real-time objective data collection, analyze and visualize longitudinal data, and to develop vital leadership skills. This research, conducted under the guidance of an interdisciplinary team of mentors, will aid the PI in cultivating skills needed to advance as an independent scientist conducting clinical research optimizing symptoms to prevent chronic pain and prolonged opioid use postoperatively.