Transition from Acute to Chronic Pain After Thoracic Surgery

PROJECT SUMMARY / ABSTRACT
Chronic post-surgical pain (CPSP) is a major cause of new chronic pain, occurring between 10 - 40% after
common surgical procedures. Thoracic surgery procedures have among the highest rates of chronic post-
surgical pain (CPSP), with roughly 30 - 47% of patients developing new chronic pain within 6 months of
surgery. While the high incidence of CPSP following thoracic surgery is well-described, the patient- and care-
factors associated with the development of CPSP are still not clear. Some factors such as anxiety have been
described; however, most cohorts lack the sample size to assess potentially important factors, including
neuroimaging, quantitative sensory testing, and blood samples for genomics, metabolomics and proteomics.
We believe that thoracic surgery is an ideal second surgical population to add to the Acute to Chronic Pain
Signatures (A2CPS) program, complementing the first MCC population of knee arthroplasty, which has much
lower rates of new CPSP but is a better cohort to identify risk factors for failure to resolve chronic pain. Our
inter-disciplinary team from the proposed University of Michigan A2CP Multisite Clinical Center (MCC) has
unparalleled expertise to examine the phenotypic and genotypic risk factors for the development of CPSP
among patients undergoing thoracic surgery. Our co-PIs include an anesthesiologist, two surgeons, and a
rheumatologist that have successfully collaborated in ongoing work, and partner within a statewide network of
hospitals performing thoracotomy procedures, the Michigan Society of Thoracic and
Cardiovascular Surgeons (MSTCVS) Quality Collaborative. Collaborative quality improvement programs
including MSTCVS are funded by Blue Cross Blue Shield of Michigan to conduct participatory, provider-driven
quality improvement initiatives, and our team has heavily leveraged these to study postoperative pain- and
opioid-related outcomes and generate best practices. The implementation and dissemination of these best
practices has dramatically reduced perioperative prescribing of opioids in the state of Michigan, and this strong
partnership will enable us to recruit thoracotomy patients from a population-based sample across diverse
healthcare systems. We will recruit 1800 patients from seven hospitals in Michigan undergoing surgery via a
thoracic approach (lung resection, esophageal resection/reconstruction, and other general thoracic surgery).
We will capture patient-reported health status alongside QST and functional neuroimaging at baseline and 6
months using a novel smart phone- and web-enabled application. At baseline and 6 months, biological
samples will also be collected. From the 1800 participants recruited, we will identify 200 cases and 200
controls of CPSP at 6 months after surgery for repeated neuroimaging, quantitative sensory testing and blood
sample collection. The successful completion of the proposed study would provide an unparalleled resource for
the understanding the factors associated with CPSP and will allow for more efficient and personalized trials to
prevent the development of chronic pain after thoracotomy and other thoracic surgeries.

Grant Number: 5UM1NS118922-03
NIH Institute/Center: NIH
Principal Investigator: Chad Brummett