Collecting Interval Timed Incisional Epidermal and Dermal Tissue Samples During Surgical Procedures to Profile Temporal Response of Tissue After Noxious Stimuli

Background:

• Opioids are the cornerstone of postoperative pain management. However, in light of the current opioid crisis, there is a recognized need for improved postoperative pain management to address pain with fewer side effects.
• New pain medications that are as effective and less problematic are a goal but much of the foundational knowledge required to meet these need is underdeveloped in human studies and are derived from rodent studies.
• We propose to identify critical human tissue nociceptive signals originating at the site of surgical incision initiating the pain response to identify biomarkers of human cutaneous pain signaling.
• Mechanisms of pain and pain sensitivities originating at the surgical site are not well understood.
• Clinical and basic research can unlock the etiology of surgical incisional pain and direct biomedicine to better address this area of underdeveloped research both now and in the future; uniquely providing opportunities to perform important studies on gene expression.

Objectives:

• Identification of transcriptional alterations in epidermal and dermal tissue of at least four (4), but up to six (6) time points during surgical procedures.
• Tandem mass spectrometry (MS/MS) measurement from human epidermal sample to identify alterations in candidate oxylipins and peptide mediators of pain, inflammation and itch.

Eligibility:

-Male or female, aged 18 years and older that are consented for a primary surgical procedure of greater than four (4) hours. Participants without skin abnormalities at tissue sampling site.

Design:

-A single cohort study, of 12 surgical participants with a scheduled surgical procedure, of at least 4 hours, at the NIH Clinical Center, for up to six (6) timed tissue sampling at surgical incision. No investigational therapy is planned.

• INCLUSION CRITERIA:

In order to be eligible to participate in this study, an individual must meet all of the following criteria:

• Male or female, aged 18 years and older. Participant will be consented for a surgical procedure (primary surgical protocol) anticipated to last longer than 4 hours.
• Cutaneous incisional tissue sample (removal) is determined by surgeon not to compromise the incisional closure.

Exclusion criteria

An individual who meets any of the following criteria will be excluded from participation in this study:

• Participants with known skin abnormalities (dermatologic /dermatitis conditions): psoriasis, atopic dermatitis, rosacea, cancer melanomas, basal cell as well as benign lesions, tissue burns, infections, hematomas, and contusions) at the surgical site.
• Participants with pre-existing scar tissue at the incision site and/or a history of surgical procedures at the same site. Pre-existing scar tissue will confound the results since the baseline is different from normal non-scar tissue and therefore cannot be used as a basis for comparison.
• Participants with a history of radiation treatment at the incision site, when the incision site was included in the radiation field.
• Participants with other skin conditions that would compromise epidermal and dermal samples in the opinion of the surgeon.
• Uncontrolled concurrent illness including, but not limited to, ongoing or active infection, or psychiatric illness/social situations (within 6 months) that would limit compliance with study requirements.
• The pain questionnaire will be only available in English, therefore non-English speaking/reading participants are excluded from participating in the study.