Mechanism-based Approach to Pain in Chronic Pancreatitis (MAP-CP Study)

项目摘要 慢性胰腺炎（CP）通常伴有严重的衰弱性疼痛，这是相当难以治疗的。 大量的止痛药，可以规定，但他们的疗效往往取决于有一个机械评估 疼痛的原因和类型。由于临床上没有可用的工具来正确地表征疼痛的子类型， 当患者正在经历疼痛时，很难选择最有可能提供充分疼痛缓解的疗法。的识别 与特定亚型疼痛相关的生物标志物谱可以为疼痛管理提供指导， 通过减少施用有效疗法所需的时间和费用， 处方阿片类药物的患者数量，并确定新的治疗靶点。本研究旨在验证这一假设 患者来源的信息可用于识别疼痛表型（生物标志物谱）， CP相关疼痛的管理。目的1将是横断面分析，以检查循环中的表达模式。 已知对疼痛信号很重要的蛋白质。我们将比较这些疼痛特征， 包括疼痛强度、频率和对生活质量的干扰。然后我们将 确定是否可以根据潜在的疼痛区分推定的生物标志物谱和疼痛特征 机制（伤害性与神经性）。目标2将涉及纵向评估是否有时间变化， 生物标志物谱与临床症状和治疗的变化相关，例如阿片类药物。这项纵向研究 将使我们能够描述相同患者的疼痛自然史。总的来说，这项研究的结果将 提供关于CP疼痛演变的深入数据，并指导未来旨在预测治疗效果的研究。 反应能力和制定有效的干预措施。

Project Summary Chronic pancreatitis (CP) is often accompanied by profoundly debilitating pain that is quite difficult to treat. There are a large number of analgesics that can be prescribed, but their efficacy often depends on having a mechanistic assessment of the cause and type of pain. Since there are no tools available in clinics to properly characterize the sub-type of pain a patient is experiencing, it is difficult to choose a therapy most likely to provide sufficient pain relief. The identification of biomarker profiles associated with specific sub-types of pain could inform guidelines for pain management that improve patients' quality of life by reducing the time and expense required to administer the efficacious therapies, reduce the number of patients prescribed opioids, and identify novel therapeutic targets. This study is designed to test the hypothesis that patient-derived information can be used to identify pain phenotypes (biomarker profiles) that inform management of CP-related pain. Aim 1 will be cross-sectional analyses to examine the expression pattern of circulating proteins that are known to be important for pain signaling. We will compare these in relation to pain characteristics that have been previously studied including pain intensity, frequency, and interference with quality of life. We will then determine if putative biomarker profiles and pain characteristics can be differentiated based on the underlying pain mechanism (nociceptive versus neuropathic). Aim 2 will involve longitudinal evaluation of whether temporal changes in biomarker profile are associated with changes in clinical symptoms and treatment, such as opioids. This longitudinal study will allow us to describe the natural history of pain within the same patients. Overall, the results from this study will provide in depth data regarding the evolution of pain in CP and guide future studies aimed at predicting therapeutic responsiveness and developing efficacious interventions.