Degenerative joint disease, particularly knee osteoarthritis (OA), is one of the most prevalent and disabling chronic pain conditions and is projected to increase sharply as the U.S. population ages. Projections also indicate that the annual number of total knee replacements, the treatment of choice for end-stage knee OA, will increase five- to ten-fold in the U.S. over the next several decades. While the outcomes following total knee arthroplasty are generally good, a substantial minority of patients continue to experience significant long-term pain and disability after surgery. These individual differences in the trajectory of pain and function after knee replacement are minimally related to findings from physical examination and imaging procedures. Our group has identified several potentially important variables that are likely to play a role in shaping long-term pain outcomes, though there are few published studies in patients with knee OA. The proposed 2-site prospective cohort project will carefully evaluate and follow a sample of patients undergoing total knee replacement. Knee OA patients will be assessed pre-surgically with a battery of psychophysical pain testing procedures, multimodal evaluation of sleep quality, continuity, and architecture, questionnaires regarding psychological function, and physiological sampling (e.g., blood and saliva samples). Outcomes such as pain, functioning, and analgesic usage will be evaluated through 12-month follow-up. These data will allow us to model the unique and combined impact of these classes of "risk factor" variables. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for selection of surgical patients and for management of post-operative pain, as well as theoretical importance in understanding the sources of individual differences in pain-related outcomes.

Public Health Relevance

Chronic pain is a critical national and international health problem, making the identification of groups at high risk for the development or persistence of chronic pain an increasingly important area of investigation. This project seeks to identify risk factors for persistent pain and physical disability following total knee replacement, a surgical procedure projected to increase five- to ten-fold in the U.S. over the next several decades. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for the selection of surgical patients, for the management of post-operative pain, and for understanding the sources of individual differences in pain-related outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG034982-04
Application #
8494493
Study Section
Biobehavioral Mechanisms of Emotion, Stress and Health Study Section (MESH)
Program Officer
Eldadah, Basil A
Project Start
2010-07-01
Project End
2015-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
4
Fiscal Year
2013
Total Cost
$590,644
Indirect Cost
$126,771
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Loggia, Marco L; Edwards, Robert R; Harris, Richard E et al. (2014) Reply: To PMID 24449585. Arthritis Rheumatol 66:1684-5
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Loggia, Marco L; Berna, Chantal; Kim, Jieun et al. (2014) Disrupted brain circuitry for pain-related reward/punishment in fibromyalgia. Arthritis Rheumatol 66:203-12
Jamison, Robert N; Martel, Marc O; Edwards, Robert R et al. (2014) Validation of a brief Opioid Compliance Checklist for patients with chronic pain. J Pain 15:1092-101
Martel, Marc O; Jamison, Robert N; Wasan, Ajay D et al. (2014) The association between catastrophizing and craving in patients with chronic pain prescribed opioid therapy: a preliminary analysis. Pain Med 15:1757-64
Martel, Marc O; Dolman, Andrew J; Edwards, Robert R et al. (2014) The association between negative affect and prescription opioid misuse in patients with chronic pain: the mediating role of opioid craving. J Pain 15:90-100
Schreiber, Kristin L; Martel, Marc O; Shnol, Helen et al. (2013) Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain. Pain 154:660-8
Martel, Marc O; Wasan, Ajay D; Edwards, Robert R (2013) Sex differences in the stability of conditioned pain modulation (CPM) among patients with chronic pain. Pain Med 14:1757-68
Jamison, Robert N; Edwards, Robert R; Liu, Xiaoxia et al. (2013) Relationship of negative affect and outcome of an opioid therapy trial among low back pain patients. Pain Pract 13:173-81
King, Christopher D; Goodin, Burel; Kindler, Lindsay L et al. (2013) Reduction of conditioned pain modulation in humans by naltrexone: an exploratory study of the effects of pain catastrophizing. J Behav Med 36:315-27

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