Biobehavioral Risk Factors for Persistent Pain following Total Knee Arthroplasty

描述(申请人提供)：退行性关节疾病，特别是膝骨性关节炎(OA)，是最常见和致残的慢性疼痛疾病之一，预计随着美国人口老龄化，这种疾病将急剧增加。预测还表明，在接下来的几十年里，美国每年的膝关节置换总数将增加五到十倍。膝关节置换是治疗终末期膝关节骨性关节炎的首选方法。虽然全膝关节置换术的结果总体上是好的，但相当少数的患者在手术后继续经历严重的长期疼痛和残疾。膝关节置换术后疼痛和功能的这些个体差异与体检和影像检查结果的相关性很小。我们小组已经确定了几个潜在的重要变量，这些变量可能在塑造长期疼痛结果中发挥作用，尽管很少有发表的关于膝骨性关节炎患者的研究。拟议的两点前瞻性队列项目将仔细评估和跟踪接受全膝关节置换术的患者样本。膝关节骨性关节炎患者将在手术前接受一系列心理物理疼痛测试程序、对睡眠质量、连续性和结构的多模式评估、关于心理功能的问卷调查以及生理采样(例如血液和唾液样本)。疼痛、功能和止痛药使用等结果将通过12个月的随访进行评估。这些数据将使我们能够对这些类别的“风险因素”变量的独特和综合影响进行建模。总体而言，确定与关节置换术后持续性疼痛和疼痛相关残疾的发展和维持相关的因素，对于选择手术患者和术后疼痛的管理具有重要的实践意义，并且对于理解疼痛相关结果的个体差异的来源具有重要的理论意义。 公共卫生相关性：慢性疼痛是一个严重的国家和国际健康问题，这使得确定慢性疼痛发展或持续的高风险群体成为越来越重要的调查领域。该项目旨在确定全膝关节置换术后持续性疼痛和身体残疾的风险因素，全膝关节置换术预计在未来几十年内在美国增加五到十倍。总体而言，确定与关节置换术后持续性疼痛和疼痛相关残疾的发展和维持相关的因素，对于选择手术患者、术后疼痛的管理以及了解疼痛相关结果的个体差异的来源具有重要的实际意义。

DESCRIPTION (provided by applicant): Degenerative joint disease, particularly knee osteoarthritis (OA), is one of the most prevalent and disabling chronic pain conditions and is projected to increase sharply as the U.S. population ages. Projections also indicate that the annual number of total knee replacements, the treatment of choice for end-stage knee OA, will increase five- to ten-fold in the U.S. over the next several decades. While the outcomes following total knee arthroplasty are generally good, a substantial minority of patients continue to experience significant long-term pain and disability after surgery. These individual differences in the trajectory of pain and function after knee replacement are minimally related to findings from physical examination and imaging procedures. Our group has identified several potentially important variables that are likely to play a role in shaping long-term pain outcomes, though there are few published studies in patients with knee OA. The proposed 2-site prospective cohort project will carefully evaluate and follow a sample of patients undergoing total knee replacement. Knee OA patients will be assessed pre-surgically with a battery of psychophysical pain testing procedures, multimodal evaluation of sleep quality, continuity, and architecture, questionnaires regarding psychological function, and physiological sampling (e.g., blood and saliva samples). Outcomes such as pain, functioning, and analgesic usage will be evaluated through 12-month follow-up. These data will allow us to model the unique and combined impact of these classes of "risk factor" variables. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for selection of surgical patients and for management of post-operative pain, as well as theoretical importance in understanding the sources of individual differences in pain-related outcomes. PUBLIC HEALTH RELEVANCE: Chronic pain is a critical national and international health problem, making the identification of groups at high risk for the development or persistence of chronic pain an increasingly important area of investigation. This project seeks to identify risk factors for persistent pain and physical disability following total knee replacement, a surgical procedure projected to increase five- to ten-fold in the U.S. over the next several decades. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for the selection of surgical patients, for the management of post-operative pain, and for understanding the sources of individual differences in pain-related outcomes.