Nonpharmacological Strategies to Mitigate Pain and Problematic Opioid Use After Spine Surgery

项目摘要/摘要 背景：在脊柱手术后的几个月里，疼痛和有问题的阿片类药物使用是常见的。的目标是 John Magel博士的NCATS/NCCIH KL2行政补充奖是为了获得必要的培训， 实践经验和知识，成为一名领先的独立调查员，专注于康复 改善和缓解慢性阻塞性肺疾病患者的不良处方阿片使用(PPOU) 肌肉骨骼状况。他提出的职业发展奖就是为了支持这一转变。他 将使用前瞻性和定性方法来确定不良适应信念的程度(痛苦- 灾难、运动恐惧症和疼痛自我效能感)对脊柱手术后阿片类药物的使用和 是否存在为改善疼痛和减少阿片类药物消费而量身定做康复的机会 有PPOU风险的患者。 研究设计和方法：脊柱手术患者的前瞻性队列将用于 确定不良适应疼痛信念与未来阿片类药物使用和身体状况的结果之间的关系 高危PPOU患者的功能。在另一组接受脊柱手术的患者中，半结构化的 访谈将被用来评估患者对术后非药物治疗的看法。 由理疗师进行的干预。目标1：在有PPOU风险的患者中，确定 脊柱手术后对阿片类药物使用和身体功能的不良适应疼痛信念。阿片类药物的使用和 脊柱手术后患者术后3~6个月身体功能的变化 将对PPOU进行评估。不适应疼痛信念之间的联系(疼痛灾难， 运动恐惧症和疼痛自我效能)对(1a)阿片类药物使用和(1b)身体功能的影响，同时控制 协变量(例如，PT的出勤率、患者的人口统计数据、合并症、手术类型)将被评估。目标2： 确定患者对非药理学术后疼痛管理策略的认知 脊柱手术后的处方阿片类药物。将使用半结构化的深度访谈来确定主题 在这些患者中，他们描述了他们对非药物术后疼痛管理的看法。 职业发展计划：KL2职业发展奖解决了我目前的这些差距 研究能力：1)发展阿片类药物风险评估和风险缓解方面的专门知识，2)发展技能 设计和实施临床试验以及卫生系统研究的定性和混合方法 3)培养独立领导和管理研究项目的技能。这些弱点将得到解决 使用犹他大学健壮的KL2计划提供的资源，并通过 推荐的课程和实践培训，以及与国际公认的 专家导师和顾问。

PROJECT SUMMARY/ABSTRACT Background: Pain and problematic opioid use is common in the months following spine surgery. The goal for Dr. John Magel's NCATS/NCCIH KL2 Administrative Supplemental Award is to acquire the necessary training, practical experience, and knowledge to be a leading independent investigator who focuses on rehabilitation to improve outcomes and mitigate problematic prescription opioid use (PPOU) in patients with chronic musculoskeletal conditions. His proposed career development award is designed to support this transition. He will use prospective and qualitative methodologies to determine the extent to which maladaptive beliefs (pain- catastrophizing, kinesiophobia, and pain self-efficacy) measured after spine surgery impacts opioid use and whether opportunities exist to tailor rehabilitation toward improving pain and reducing opioid consumption in patients at risk for PPOU. Research Design and Methods: A prospective cohort of patients who had spine surgery will be used to determine associations between maladaptive pain beliefs and the outcomes of future opioid use and physical function in patients at risk PPOU. In a separate cohort of patients who had spine surgery, semi-structured interviews will be used to evaluate the perceptions of patients related to post-surgical nonpharmacologic interventions performed by physical therapists. Aim 1: In patients at risk for PPOU, determine the impact of maladaptive pain beliefs measured after spinal surgery on opioid use and physical functioning. Opioid use and physical function during the 3-6 month postoperative period in patients after spine surgery who are at risk for PPOU will be evaluated. The association between maladaptive pain beliefs (pain catastrophizing, kinesiophobia, and pain self-efficacy) on (1a) opioid use and (1b) physical function while controlling for covariates (e.g., attendance in PT, patient demographics, comorbidities, surgical type) will be assessed. Aim 2: Determine the perceptions of nonpharmacologic postoperative pain management strategies in patients using prescription opioids after spine surgery. Semi-structured, in-depth interviews will be used to identify themes among the patients that describe their perceptions of nonpharmacologic postoperative pain management. Career Development Plan: The KL2 Career Development Award with address these gaps in my current research abilities: 1) develop expertise in opioid risk assessment and risk mitigation, 2) develop skills in designing and conducting clinical trials and in and qualitative and mixed methods for health systems research 3) cultivate skills to independently lead and manage a research program. These weaknesses will be addressed using the resources the resources provided by the university of Utah's robust KL2 program and through recommended courses and hands-on training as well as interacting with an international recognized team of expert mentors and advisors.