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With the goal of advancing pain management, Anesthesia Research investigates novel interventions that assure patient safety and comfort throughout the perioperative period. Focused areas within the department include:
An integration of bench, animal and clinical studies form the foundation of our research program. Currently there several key research initiatives underway.
The development of treatment algorithms within the Pain Division lends itself to the systematic study of treatment outcomes which in turn suggest the refinement of best practices. Pretreatment psychometric testing, biological markers, and examination findings have been used to predict long-term functional outcomes in spinal and neuropathic pain treatments. Research is being conducted to develop normalized scores for the BSI-18, a screening and outcome tool for use in a chronic pain population. Medication management protocols are being coordinated with the development and implementation of these screening algorithms. Database development is underway for both the acute pain service and chronic pain service to facilitate outcomes research.
Previous investigations into pain predisposition in animal and bench models have led us back to the hypothesis that the development of chronic pain states in humans is in large part genetically predetermined. A collaborative effort with genetics researchers at Oakland University has been funded. This project involves the establishment of a database linking posttraumatic outcomes to genetic profiles. It includes an undergraduate laboratory course (BIO 491 ST: Clinical Genetics Research) where students learn the fundaments of clinical research from the bedside and the bench perspectives: a translational research experience. A grant has been submitted for NIH funding.
We are interested in improving our ability to evaluate all patients for pain in accordance with the 5th Vital Sign Initiative. Patients who are unable to communicate through self-report are vulnerable and therefore liable to suffer unrecognized and hence unrelieved pain. After studying observational scales in toddlers we turned our attention to adults. The development of the Postoperative Observational Pain Scale for Older Adults (POPS) has been completed and submitted for publication. Validating this tool in the cognitively impaired will be the next step in this project.
Finally, we plan to return to the study of postoperative pain in toddlers. Distinguishing between anxiety, delirium and pain can be challenging in this age group. A study designed to improve pain management and postoperative cognitive function will be used as a vehicle to improve our methods for assessing pain and anxiety in the PACU of the Center for Children's Surgery.
Although we have engaged in a number of diverse projects covering anesthesiology, acute and chronic pain, our niche in sponsored clinical trials has been orthopedic postoperative pain states. Our strategic plan includes continued expansion into the areas of demonstrated expertise including: muscle relaxants, awareness/depth of anesthesia and its effect on postoperative cognitive dysfunction, and nausea, orthostasis and autonomic control. We have had success in multicenter trials at Beaumont in the development of novel drug delivery systems: sustained-release epidural morphine, now called DepoDur and E-TRANS, now called IONSYS. We continue to participate in trials for conditions such as postoperative nausea, postoperative cognitive dysfunction, complement inhibition following bypass, opioid-induced constipation, and catheter-induced infection, and novel agents for postoperative pain control.
Clinical questions arising in daily practice and quality assurance issues provide the basis for much of the intramural research strategic plan. Examples of this process not previously mentioned include the use of an NK-1 antagonist to prevent intractable nausea and vomiting following sustained-release epidural morphine (submitted for publication), outcomes following shoulder surgery using continuous interscalene regional analgesia, an algorithmic approach to the analgesia in opioid tolerant acute pain inpatients, and tendon-bone healing in the presence of COX-2 analgesics.
Anesthesiology Researchers, including nearly a dozen sub-investigators in the Anesthesia Departments at Beaumont Hospitals, were leaders in the development of protocols and successful completion of clinical FDA trials leading to FDA approvals for DepoDur, IONSYS and Nucynta (tapentadol). DepoDur is a sustained-release epidural morphine that allows for 48 hours of relief following a single injection, thus eliminating the need for a catheter and pump system. This is especially important in patients who are unable to use epidural infusions for postoperative pain control due to the need for anticoagulation as is the case in total joint replacement surgery. IONSYS is a novel delivery system for patient-controlled analgesia that is a small (credit card sized) system which adheres to the skin. It allows for the painless, needleless introduction of pain relieving medication directly through the skin when activated by the patient. Again, the elimination of pumps and catheters provides added convenience and mobility for postoperative patients. Tapentadol is a novel oral analgesic with a dual mode of action: opioid agonism and norepinephrine reuptake inhibition. This dual action allows for a dramatic reduction in gastrointestinal side effects compared to equivalent doses of opioid analgesics.
Research awards have been received in the form of non-commercial grant funding from the following organizations: DeRoy Testamentary Foundation, Beaumont Foundation, Oakland University/Beaumont Hospital, Pfizer (unrestricted grant for basic science), and Merck (unrestricted grant for clinical science). Papers and posters have been selected for special recognition including the following awards and honors: Citation Award (American Pain Society) and selection for AnalgesiaFile (Dannemiller Education Foundation). Our outstanding clinical nursing staff has also been recognized as leaders in the field and selected as coordinator leaders to train other sites around the country.
Craig T. Hartrick, MD, DABPM, FIPP
Director, Anesthesiology Research
Postoperative pain, Neuropathic pain, Regional Anesthesia, Pain Measurement
Craig Ramsdell, MD
Associate Director, Anesthesiology Research
Aerospace physiology, Nausea, Obstetrical analgesia
Roy Soto, MD
Director, Anesthesia Education
Awareness, cognitive dysfunction, muscle relaxants
Yeong Tang, MD
Chief, Cardiac Anesthesia - Troy
Cardiac anesthesia, postoperative nausea
Don Siwek, MD
Director, Acute Pain Service - Royal Oak
Regional anesthesia, continuous nerve blocks, ultrasound guidance
Cecile Pestano, RN, BSN, CCRPAssociate Nurse Manager, Clinical ResearchPhone: 248-964-3440Fax: 248-964-3112E-mail: email@example.com