Snyder McKenzie, Shugars Daniel A, White Raymond P, Phillips Ceib
Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.
J Oral Maxillofac Surg. 2005 Aug;63(8):1130-7. doi: 10.1016/j.joms.2005.04.004.
Purpose This study was designed to assess the impact of taking pain medications, as a more comprehensive indicator of perceived pain, on the extent of interference with lifestyle and oral function during recovery after third molar surgery. Patients and Methods Recovery data after the removal of 4 third molars were available for patients enrolled in an institutional review board-approved, prospective, multicenter clinical trial. A self-administered health-related quality of life instrument, designed to assess a patients perception of recovery for pain, lifestyle, and oral function, was completed each postsurgery day (PSD) for 14 days. Taking pain medications was a proxy for a patients perceived level of pain, adding a more sensitive behavioral component to the report of pain. Each PSD day, the patients who thought that their pain was sufficient to require taking medications (an opioid, a nonsteroidal anti-inflammatory, or the combination) were compared with patients not taking pain medications. The extent of interference in lifestyle (daily activity, social life, recreation, sleep) and in oral function (eating, chewing, mouth opening) as self-reported on a scale of 1 (no trouble) to 5 (lots of trouble) were compared for those taking and not taking medications using Cochran-Mantel-Haenszel row mean statistics ( P < .05). Results The 445 study patients were mostly female (63%) and white (86%). Median age was 20 years (IQ, 18, 24 years). Median surgery time was 30 minutes (IQ, 20, 40 minutes). Both mandibular third molars were below the occlusal plane in 60%. Almost all patients took pain medication on PSD 1. By PSD 7, 48% of patients were taking pain medication, decreasing to 20% by PSD 11. Patients with pain sufficient to take an analgesic reported a greater extent of interference for all lifestyle and oral function measures. Recovery was significantly delayed for PSD 2 through 14 for patients who took medications ( P < 0.01). Recovery for females taking pain medications was significantly delayed compared with that for males. Conclusions Patients with pain sufficient to prompt taking pain medications were likely to report interference with recovery for lifestyle and oral function. A patients choice to take pain medication appears to be a better indicator of a patients perceived pain and the impact of that pain on recovery than numerical pain scales. This method provides more sensitive behavioral information during the period of recovery after third molar removal.
目的 本研究旨在评估服用止痛药物（作为感知疼痛的更全面指标）对第三磨牙手术后恢复期间生活方式和口腔功能受干扰程度的影响。
患者与方法 纳入一项经机构审查委员会批准的前瞻性多中心临床试验的患者，可获取其拔除4颗第三磨牙后的恢复数据。一种自行填写的与健康相关的生活质量工具，旨在评估患者对疼痛、生活方式和口腔功能恢复的感知，在术后14天内每天（术后日，PSD）填写。服用止痛药物是患者感知疼痛程度的一个替代指标，为疼痛报告增加了更敏感的行为成分。在每个PSD日，将认为自己疼痛程度足以需要服用药物（阿片类药物、非甾体抗炎药或两者联用）的患者与未服用止痛药物的患者进行比较。使用 Cochr an-Mantel-Haenszel 行均值统计方法（P <.05），比较服用和未服用药物的患者在生活方式（日常活动、社交生活、娱乐、睡眠）和口腔功能（进食、咀嚼、张口）方面自我报告的干扰程度，范围为1（无困难）至5（困难重重）。
结果 445名研究患者大多为女性（63%）且为白人（86%）。中位年龄为20岁（四分位间距，18至24岁）。中位手术时间为30分钟（四分位间距，20至40分钟）。60%的患者双侧下颌第三磨牙低于咬合平面。几乎所有患者在术后第1天服用止痛药物。到术后第7天，48%的患者仍在服用止痛药物，到术后第11天降至20%。疼痛程度足以服用镇痛药的患者在所有生活方式和口腔功能指标上报告的干扰程度更大。服用药物的患者在术后第2天至第14天的恢复明显延迟（P < 0.01）。服用止痛药物的女性患者的恢复与男性相比明显延迟。
结论 疼痛程度足以促使服用止痛药物的患者可能报告生活方式和口腔功能恢复受到干扰。患者选择服用止痛药物似乎比数字疼痛量表更能体现患者感知的疼痛及其对恢复的影响。该方法在第三磨牙拔除后的恢复期间提供了更敏感的行为信息。
