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.