The proposed work addresses the following FY20 CPMRP Focus Area: Chronification of pain (i.e., the transition of acute pain to chronic pain): Understanding mechanisms of the transition from acute to chronic pain following trauma; and identification of risk/protective biomarkers for patients susceptible to chronification. Additionally, the following approaches will be incorporated into the proposed research: (1) chronic pain conditions with high prevalence in military populations; and (2) established models of pain assessment that include pain interference in emotional and physical functioning.
The incidence of chest trauma represents 10%-15% of all traumas, of which 85% of patients have rib fractures. In addition, while chest trauma still accounts for 8.6%-16% of casualties in modern wars, the decreased acute mortality of combat-related chest trauma has shifted the main clinical and research effort to prevent the long-term effects of that trauma, such as chronic pain. Patients (either civilian or military) who sustain blunt trauma injury of the chest and suffer from multiple rib fractures will often complain of persistent pain, which is present even several months after the initial injury. At present, there are no known methods to predict which patient will develop persistent pain after injury and which patient will be resilient to persistent pain. We suspect that presumable risk factors are related to multiple features related to both clinical factors (i.e., previous health status of the patients before injury including their medication and pain treatment during acute injury), their pain tolerance status, inherited elements (genetics) and also how the brain itself responds to injury.
The objective of this research proposal is to identify factors that predict the transition from acute to chronic pain or predict resilience to the development of chronic pain in patients after acute injury. It is also possible that similar factors play a role in experiencing prolonged pain in other types of trauma and injuries. It is therefore possible that these factors could be more widely applied in other areas of medicine. The methods investigated in this proposal are widely available in most tertiary medical centers and can be applied without any risk to patients after acute injury of the chest with multiple rib fractures.
The immediate benefit of this study will allow for the identification of patients at risk for chronic pain and allow allocation of resources to those most at risk. Subsequently, results may identify novel targets for intervention that will aid in the development of new therapeutic methods, protocols, or techniques that can be used in the immediate period after injury (i.e., during initial hospitalization). This will significantly improve patient outcomes by minimizing the risk of persistent pain, decreasing pain-related disability, and returning the patient more quickly to active life and work. Therefore, the results of this study will have immediate clinical applicability.
As far as the likely contributions of the proposed research project to advancing the field of chronic pain research, we will use state-of-the-art methods in genetic analysis and functional brain imaging (functional brain MRI) to identify new genetic variants and neuronal pathways which can predict the probability of developing chronic pain after injury. By utilizing real patients in real clinical scenarios (i.e., human pain model), our results will be directly and rapidly applied in clinical scenarios, allowing resources to be targeted to the most vulnerable, thereby improving the quality of life of patients after injury by preventing persistent pain.
|Effective start/end date||1/1/20 → …|
- Congressionally Directed Medical Research Programs: $1,450,288.00