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Personalizing Perioperative Preventive Analgesia: Translational Studies Investigating the Biopsychosocial Underpinnings of Enhanced Pain Propensity

Award Number: R35GM128691
ORGANIZATION: NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY Over 230 million people undergo surgery annually. The experience of postsurgical pain varies among individuals, but a significant proportion (20-30%) of patients experience surgical site pain lasting at least a year postoperatively. Such Persistent Post-Surgical Pain (PPSP) causes physical and mental suffering and disability and lengthens exposure to opioid analgesics, potentially placing patients at risk of addiction. Despite excellent research in basic research indicating potential mechanisms involved in the transition of acute to chronic pain, little success at translating these findings to actual prevention of persistent postoperative pain in human patients has been realized. My research program has developed a working human model of this transition, by systematic and longitudinal studying pain before, during and after a variety of surgeries. We have identified several patient-level risk factors that predict who is high-risk for developing PPSP, allowing more efficient study of this problem, as well as insight into relevant mechanisms, in humans. A crucially important factor in determining the trajectory of PPSP appears to be the tendency for the pain signal to be amplified. While pain amplification may be protective in the short term, it becomes dysfunctional if excessive or persistent. In our psychophysics lab, we study measures that indicate excessive amplification response of the nervous system in some individuals in response to standardized pain testing. We also measure psychosocial factors such as stress, sleep disruption, and catastrophizing (a mental process by which rumination, magnification, and worry increase salience and importance), which can also amplify the pain signal. Importantly, pain amplification is more prominent in some individuals, and accounts for a sizeable amount of the variation in pain resulting from surgery (and far more than the surgical extent). We have developed a system to easily and non-invasively test this “amplification phenotype” in individuals BEFORE surgery, using modified bedside quantitative sensory tests, and brief, validated psychosocial questionnaires. My research program has optimized measurement of our patients’ preoperative amplification phenotype, to help target both known and novel non-opioid preventive treatments to these high-risk individuals. Our goals for the next 5 years of this R35 award are: (1) to efficiently target the prevention of persistent pain and opioid use after surgery in high-risk individuals, (2) to understand and target the underlying mechanisms contributing to the development of PPSP, including understanding how pain amplification relates to the inflammatory response to surgery, (3) to more widely apply preventive strategies, understanding their differential efficacy among diverse samples of patients. As an Anesthesiologist with formal training in pain neuroscience, psychophysical and psychosocial assessments, and practical experience in conducting translational studies, I am well-situated to conduct such well-designed mechanistic studies.


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 = $0 )
2025	2024	BRIGHAM & WOMENS HOSPITAL INC	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	000	7	11/6/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $519,100 )
2024	2024	BRIGHAM & WOMENS HOSPITAL INC	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	000	7	8/27/2024	NON-COMPETING CONTINUATION	$519,100
														Subtotal = $519,100

Issue Date FY: 2023 ( Subtotal = $519,100 )
2023	2023	BRIGHAM & WOMENS HOSPITAL INC	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	000	6	7/24/2023	COMPETING CONTINUATION	$519,100
														Subtotal = $519,100

Issue Date FY: 2022 ( Subtotal = $551,097 )
2022	2022	BRIGHAM & WOMENS HOSPITAL INC	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	000	5	8/24/2022	NON-COMPETING CONTINUATION	$424,814
2022	2022	BRIGHAM & WOMENS HOSPITAL INC	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	001	5	8/25/2022	SUPPLEMENT FOR EXPANSION	$126,283
														Subtotal = $551,097

Issue Date FY: 2021 ( Subtotal = $574,059 )
2021	2021	BRIGHAM AND WOMEN'S HOSPITAL, INC., THE	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	002	4	9/3/2021	SUPPLEMENT FOR EXPANSION	$137,764
2021	2021	BRIGHAM AND WOMEN'S HOSPITAL, INC., THE	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	000	3	6/24/2021	SUPPLEMENT FOR EXPANSION	$11,481
2021	2021	BRIGHAM AND WOMEN'S HOSPITAL, INC., THE	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	001	4	9/2/2021	NON-COMPETING CONTINUATION	$424,814
														Subtotal = $574,059

Issue Date FY: 2020 ( Subtotal = $437,344 )
2020	2020	BRIGHAM AND WOMEN'S HOSPITAL, INC., THE	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	000	3	8/19/2020	NON-COMPETING CONTINUATION	$437,344
														Subtotal = $437,344

Issue Date FY: 2019 ( Subtotal = $424,814 )
2019	2019	BRIGHAM AND WOMEN'S HOSPITAL, INC., THE	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	001	2	8/23/2019	NON-COMPETING CONTINUATION	$424,814
2019	2018	BRIGHAM AND WOMEN'S HOSPITAL, INC., THE	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	000	1	10/23/2018	NEW	$0
														Subtotal = $424,814

Issue Date FY: 2018 ( Subtotal = $439,134 )
2018	2018	BRIGHAM AND WOMEN'S HOSPITAL, INC., THE	75 FRANCIS ST	BOSTON	MA	02115	SUFFOLK	USA	Biomedical Research and Research Training	000	1	8/23/2018	NEW	$439,134
														Subtotal = $439,134

Grand Total All Awards = $3,464,648

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Personalizing Perioperative Preventive Analgesia: Translational Studies Investigating the Biopsychosocial Underpinnings of Enhanced Pain Propensity

Award Number: R35GM128691

ORGANIZATION: NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

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

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