Acute to Chronic Pain Signatures (A2CPS) | The Common Fund

Program Snapshot

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The goal of the Acute to Chronic Pain Signatures (A2CPS) program is to develop a set of objective biomarkers that provide “signatures” to predict if chronic pain is likely to develop or be resolved after acute pain, like an injury or after a surgery. These signatures are greatly needed because prevention of chronic pain is a major challenge in pain management. For most people, acute pain resolves as the injury that caused it heals. Yet in many other people, pain from an injury, surgery, or disease persists lasts for years or even throughout life becoming a chronic condition. This high prevalence of chronic pain has in part contributed to the current opioid epidemic in the US. A signature that could be identified before the transition from acute to chronic pain could help accelerate therapy development and ultimately guide pain prevention strategies.

To uncover signatures predictive of the transition to or resilience from chronic pain, the A2CPS clinical study will collect imaging, physical, sensory, and other data from two groups of people for six months; one group will have recently had Total Knee Arthroplasty (TKA) surgery and the other will have had a thoracic surgery. The hope is for differences in biomarkers observed between people who transition to chronic pain and those who do not will reveal biomarkers associated with the transition to chronic pain. The biomarkers could then be combined into signatures predictive of the transition. Clinical sites are now enrolling participants in this important research study.

A major challenge in pain management is preventing chronic pain from occurring after an acute pain event. For most people, acute pain resolves as the injury or trauma that caused it heals. Yet in many other people, acute pain from injury, surgery, or disease persists beyond the initial insult, and can last for years or throughout life. Many drugs, while effective early on, lose efficacy over time and make the transition from acute to chronic pain worse. In those who transition to chronic pain, maladaptive changes occur throughout the nervous system. Our ability to reverse these changes is very limited. Our lack of understanding of the mechanisms of transition to chronic pain is a major gap in knowledge that limits development of effective preventive therapies. The ability to identify those at risk for transitioning to chronic pain could inform future clinical trials, improve success of trials, and transform acute pain treatment approaches for prevention of chronic pain.

The Acute to Chronic Pain Signatures program will use advances in imaging, high-throughput biomedical experiments (‘omics), sensory testing, and psychosocial assessments to explore a range of characteristics from patients who transition or are resilient to chronic pain. The study will follow two groups from the time of acute pain event over a period of six months. One group will have undergone a total knee arthroplasty (TKA) and the other will have undergone thoracic surgery. The key deliverable of the program is a comprehensive data set for the research communities that should reveal “signatures” predictive of transition versus resilience to chronic pain.

Health Relevance

The United States is facing a crisis not only in opioid misuse and overdose, but also in effective treatment options for many suffering from high levels of chronic pain. More and more Americans are suffering from chronic pain, creating an urgent need for safer, more effective pain treatments to reduce long-term reliance on opioids. One major challenge is the ability to prevent chronic pain after an acute pain event. Currently, researchers don’t fully understand how acute pain becomes chronic pain in some people and not others. This is a major barrier to development of effective chronic pain prevention strategies. Markers or a “signature” that could be identified in people at risk to transition to chronic pain could transform how we currently treat patients with acute pain and how we approach prevention of chronic pain. The Acute to Chronic Pain Signatures program is designed to uncover a set of biomarkers that provide a signature predictive of the transition from acute to chronic pain by studying groups of patients over the six months after an acute pain event.

This Common Fund-funded program enhances the objectives of the HEAL (Helping to End Addiction Long-term^SM) Initiative , an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. A2CPS-generated data about the transition from acute to chronic pain will benefit the NIH HEAL Initiative^SM research priority to enhance pain management. A2CPS is funded by the NIH Common Fund, and not HEAL, so it represents an additional commitment by the NIH to address the opioid public health crisis.