Chronic pain affects 50 million Americans — and for many, that pain first develops after undergoing surgery. Although 10-40 percent of surgery patients develop chronic postsurgical pain, little is known about patient characteristics and clinical care factors that may increase a patient’s CPSP risk.
Now an interdisciplinary University of Michigan team is set to conduct the largest study ever for chronic postsurgical pain in an effort to understand risk factors associated with its development. The U-M team is one of two chosen as a participant recruitment site supported by the National Institutes of Health Common Fund’s Acute to Chronic Pain Signatures (A2CPS) Program.
The group received a three-year, $6.4M NIH grant to research thoracic surgery patients, a patient population in which approximately 30-47 percent develop chronic postsurgical pain. Co-principal investigators on the grant are Dr. Chad Brummett (Anesthesiology), Dr. Andrew Chang (Surgery), Dr. Daniel Clauw (Anesthesiology, Internal Medicine and Psychiatry) and Dr. Jennifer Waljee (Surgery).
“We know that for essentially every surgery where there’s an incision made, some portion of that patient population will develop chronic postsurgical pain. And once a person develops postsurgical pain, it can be really challenging to treat,” Brummett said.
“We are excited to work within this larger NIH consortium to better understand the individual patient and care factors associated with chronic pain outcomes.”
Poor pain and opioid-related outcomes are among the most common postoperative complications, Waljee said, and can have a profound, long-term impact on quality of life for patients.
“This opportunity will allow us to understand the mechanisms that underlie the risk of chronic pain after surgery and provide us the evidence needed to better tailor our postoperative care and avoid these adverse outcomes,” she said.
The group will recruit 1800 thoracic surgery patients to participate in the study from hospitals across the state through the Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS). As an integral element of the MSTCVS, the MSTCVS Quality Collaborative, funded by Blue Cross Blue Shield of Michigan, includes cardiothoracic surgeon representatives, data managers and quality improvement teams whose aim is to improve care in cardiac and general thoracic surgery through interactive learning, shared review of outcomes and practices and implementation of consensus-based quality improvement initiatives. This large-scale effort to address chronic pain following cardiothoracic surgery will allow researchers to enroll patients statewide from diverse socioeconomic, racial and ethnic backgrounds, as well as from varying healthcare systems.
The consortium will collect neuroimaging, quantitative sensory testing, and blood samples to look at “-omics” factors — genomics, proteomics and metabolomics — before surgery and again at six weeks, three months and six months post-surgery. The goal is to identify common patient features, or signatures, that predict risk of or resilience to chronic pain.
“What we are starting to think about — and where this consortium is going to take the next steps — is to build on our understanding of some of the brain signatures that you see through functional MRIs and incorporate a broader group of biomarkers to better identify patients at risk for the development of chronic pain and markers of resilience,” Brummett said. “If we know there’s a high-risk population and can define who that is, we can begin to study and apply precision medicine interventions that may prevent chronic pain.”