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2022 DREAM Innovation Grant Recipients
Dr. Lisa M. Einhorn
BACKGROUND
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MD: University of Maryland Residency: Duke University Fellowship: Pediatric Anesthesiology: Duke
University
PILOT STUDY
Pain in children remains a prevalent concern because it is often under-recognized and undertreated and has the potential to result in lifelong comorbidities. Evidence shows that untreated pediatric pain incurs a high risk for the subsequent development of persistent pain, disability and psychological disorders in adulthood. Approximately 20 percent of adult chronic pain patients report a history of poorly managed pain in childhood or adolescence. Currently, there is limited guidance from pediatric governing bodies for both intraoperative and postoperative care which results in haphazard approaches to analgesia.
Methadone is a cost effective, efficacious and long-acting opioid. A single intraoperative dose has been used safely in adult surgical populations and has been shown to reduce opioid consumption, decrease pain scores and increase patient satisfaction when compared with shorter acting opioids. Methadone use in pediatrics has been reported in clinical trials in patients having major surgery but has not been studied in routine pediatric surgeries. This has limited its generalizability for perioperative use in children. The 2022 DIG will allow Dr. Lisa Einhorn to pursue a randomized pilot study examining intraoperative methadone use for pediatric tonsillectomy, a common procedure. The clinical trial will investigate methadone’s effect on postoperative opioid utilization and determine the optimal dose to be used in subsequent trials. This work will provide preliminary data for future grants to improve perioperative pain management for children.
Dr. Shad B. Smith
BACKGROUND
PhD: McGill University (Canada)
PILOT STUDY
Genetic factors substantially affect one’s risk of developing a chronic pain disorder, with potentially hundreds of genes contributing to common pain syndromes. Dr. Shad Smith’s lab investigates the genetic causes of chronic pain using genome-wide screens (known as GWAS) to identify novel risk factors for many such disorders in search of effective, non-addictive treatments for pain. His work with the OPPERA study culminated in a GWAS of temporomandibular disorders (TMD) incorporating data from more than 300,000 people. The principle finding from this study was a novel TMD risk gene MRAS, which codes for an important cellular signaling enzyme M-Ras. This gene was associated with healing and resilience against chronic pain via an undetermined mechanism that seems to be active in males only. The contribution of MRAS to pain-relevant pathways is an entirely unexplored area, making this a promising direction for target discovery, in addition to revealing a previously undetected sex dimorphism in nociception.
Smith will use his 2022 DIG to better understand the function of MRAS, conducting experiments to characterize the influence of M-Ras on neuronal pathways and establish a basis for future translational studies. The potential clinical utility of this discovery lies in determining the cellular mechanisms by which this gene promotes analgesia and/or healing in a patient who has suffered an injury or trauma - leveraging the body’s own potential to activate innate healing processes.
INNOVATIVE INNOVATIVE RESEARCHX
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Providing state-of-the-art methodology for clinical, basic science and translational research empowers Duke Anesthesiology to explore revolutionary clinical inquiries by using innovative investigation methods.
Through significant research in neuroscience, molecular biology, molecular and human pharmacology endeavors, our team is making crucial advancements for patients worldwide.
Jamie Privratsky, MD, PhD
RESEARCH: Annexin A1-Mediated Mitochondrial Protection to Ameliorate Surgical Kidney Injury
Michael Devinney, MD, PhD
RESEARCH: Blood-Brain Barrier Breakdown in Sleep Apnea and Postoperative Delirium
Melissa E. Bauer, DO
RESEARCH: Large-Scale Implementation of Community Co-Led Maternal Sepsis Care Practices to Reduce Morbidity and Mortality from Maternal Infection
