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Mechanisms of transition from acute to chronic pain in youth undergoing musculoskeletal surgery

Award Number: R01AR073780
ORGANIZATION: NATIONAL INSTITUTE OF ARTHRITIS & MUSCULOSKELETAL & SKIN DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Chronic postsurgical pain (CPSP) has been recognized as a major health concern across the lifespan. Adolescents undergoing invasive musculoskeletal surgeries are particularly at risk for CPSP, which occurs in about 20% of youth after surgery. CPSP is associated with significant functional disability and reduced physical and psychosocial health-related quality of life. Chronic pain in adolescence also places individuals at risk for chronic pain in adulthood, as well as risk for substance use disorder, generating potential lifelong consequences on functioning, productivity, and quality of life. In our own preliminary studies in a small sample of adolescents having major surgery, we demonstrated that (1) youth who develop CPSP may follow distinct recovery patterns that emerge within the first 2 weeks following surgery, and (2) baseline psychosocial risk factors predict development of CPSP. However, further studies are needed to understand recovery during the initial weeks following surgery when acute postsurgical pain begins to transition to CPSP. Although there is indication from prior studies that psychosocial factors may play a role in CPSP, there has been limited data on further biopsychosocial mechanisms that influence the transition from acute to chronic pain after musculoskeletal surgery in adolescents. These gaps in knowledge have limited the development and implementation of perioperative interventions targeted at the mechanisms of the transition from acute to CPSP to positively alter the trajectory of postsurgical recovery. Thus, this project aims to 1) develop valid and reliable acute recovery indices using short-term trajectories of pain, sleep quality, mood, and physical function over the first 30 days following spinal fusion surgery, and 2) determine the psychosocial and psychophysical mechanisms contributing to the transition from acute to chronic postsurgical pain. To address these aims, we propose a 2-site prospective longitudinal cohort study in 160 youth aged 10 to 18 years undergoing spinal fusion surgery, and their parents. Prospective assessments of pain, health, and functional outcomes will be collected before surgery and at three time points during the 6 months after surgery. Immediately after surgery, adolescents will complete daily monitoring of pain, sleep quality, mood, and physical function in the first 30 days following hospital discharge using ecological momentary assessment. These data will be used to develop valid and reliable acute recovery indices that predict CPSP at 3 and 6 months post-surgery. We will measure two potential sets of mechanisms underlying the transition from acute to CPSP, psychosocial variables and laboratory-based psychophysical pain responses, before surgery and at 8-weeks post-surgery in order to determine the temporal influence on subsequent development of CPSP. This study will increase understanding of the transition from acute to chronic postsurgical pain and the causal mechanisms involved. The long-term goal of this research program is to develop effective perioperative interventions to reduce exposure to opioids and decrease incidence of CPSP in adolescents undergoing musculoskeletal surgeries.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$5,456 )
2025	2022	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Arthritis, Musculoskeletal and Skin Diseases Research	000	5	10/29/2024	NON-COMPETING CONTINUATION	-$5,456
														Subtotal = -$5,456

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2022	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Arthritis, Musculoskeletal and Skin Diseases Research	000	5	6/29/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $580,076 )
2022	2022	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Arthritis, Musculoskeletal and Skin Diseases Research	000	5	7/6/2022	NON-COMPETING CONTINUATION	$580,076
														Subtotal = $580,076

Issue Date FY: 2021 ( Subtotal = $589,465 )
2021	2021	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Arthritis, Musculoskeletal and Skin Diseases Research	000	4	6/23/2021	NON-COMPETING CONTINUATION	$589,465
														Subtotal = $589,465

Issue Date FY: 2020 ( Subtotal = $625,617 )
2020	2020	SEATTLE CHILDREN'S HOSPITAL	4800 SAND PT WAY NE	SEATTLE	WA	98105	KING	USA	Arthritis, Musculoskeletal and Skin Diseases Research	000	3	7/9/2020	NON-COMPETING CONTINUATION	$625,617
														Subtotal = $625,617

Issue Date FY: 2019 ( Subtotal = $628,917 )
2019	2019	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Arthritis, Musculoskeletal and Skin Diseases Research	000	2	5/23/2019	NON-COMPETING CONTINUATION	$628,917
														Subtotal = $628,917

Issue Date FY: 2018 ( Subtotal = $640,542 )
2018	2018	SEATTLE CHILDREN'S HOSPITAL	4800 SAND POINT WAY NE	SEATTLE	WA	98105	KING	USA	Arthritis, Musculoskeletal and Skin Diseases Research	000	1	7/12/2018	NEW	$640,542
														Subtotal = $640,542

Grand Total All Awards = $3,059,161

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Mechanisms of transition from acute to chronic pain in youth undergoing musculoskeletal surgery

Award Number: R01AR073780

ORGANIZATION: NATIONAL INSTITUTE OF ARTHRITIS & MUSCULOSKELETAL & SKIN DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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