A Multisystem Resilience Approach in the Assessment of Postsurgical Pain Trajectories

PROJECT SUMMARY/ABSTRACT Osteoarthritis affects approximately 30 million people in the United States and is the leading cause of pain and disability among older adults. Total joint arthroplasty (TJA) is among the most common elective surgery for patients with refractory knee and hip arthritis. Although a proportion of patients achieve benefits from TJA, up to 34% of patients develop chronic postsurgical pain (CPSP) following the procedure, with approximately 33% of patients experiencing high impact or bothersome pain. While risk factors underlying CPSP following TJA have been well documented, the mechanisms of resilience that predict treatment success are poorly characterized and not routinely assessed. Building on prior research, we propose a novel conceptual model of pain resilience that defines resilient functioning as a dynamic and multidimensional process that engages numerous systems, a concept referred to as multisystem pain resilience (MSPR). In our preliminary work, we have found that individuals with a greater degree of protective resources across multiple domains (i.e., psychological, social, health) exhibit more optimal psychological, physical, and pain-related functioning when compared to those with a lower resilient phenotype. Thus, investigating a broad range of adaptive factors may provide important predictive insights into the unique combination of resources that account for resilient response trajectories following TJA. In line with the Precision Medicine Initiative, the aims of this prospective observational study are to explore mechanisms associated with treatment response in patients undergoing knee and hip arthroplasty, and to characterize associations between MSPR phenotypic profiles with pain impact and physical function trajectories. To address this goal, 300 patients ages 18+ years undergoing knee and hip arthroplasty will undergo prospective assessments of MSPR factors and outcomes at baseline and at five postsurgical time points over a 9-month period. Patients will complete measures across the following MSPR domains comprised of modifiable factors associated with pain: 1) demographic, 2) health, 3) biological, 4) behavioral, 5) psychological, and 6) sociological. Collectively, these aims have the potential to advance understanding of phenotypic mechanisms underlying postsurgical pain impact and physical function trajectories and may be a step toward the development of therapeutic modalities aimed at promoting enhanced recovery and reducing overall pain burden in patients undergoing arthroplasty.