Staal E, Nienhuijs S W, Keemers-Gels M E, Rosman C, Strobbe L J A
Department of Surgery, University Medical Centre st. Radboud, Nijmegen, The Netherlands.
Hernia. 2008 Apr;12(2):153-7. doi: 10.1007/s10029-007-0297-1. Epub 2007 Oct 31.
In groin hernia repair studies, chronic pain is a frequently used primary endpoint. However, its impact on daily life activities has been less investigated. Such an outcome is relevant for the patient and surgeon and cannot be extrapolated out of pain scores. The Pain Disability Index (PDI), a questionnaire wherein patients rate their impairment, could reveal the consequences of pain. The PDI was therefore introduced in a trial upon open mesh-based inguinal hernia repair.
A total of 172 patients received an open preperitoneal repair or Lichtenstein procedure. Primary endpoints for this report were the PDI scores measured preoperatively, after 2 weeks and 3 months. The Visual Analogue Scale pain (VAS) scores were assessed simultaneously. Chronic pain was defined as any VAS score at 3 months postoperatively.
The PDI scores of all measure moments were available for 146 patients (85%). A correlation between the PDI and VAS score was found at all moments (P<0.001). A total of 47 patients reported chronic pain. The intensity of their pain correlated more significantly with the PDI than VAS scores at 2 weeks postoperatively (R=0.286, P<0.001 vs. R=0.175, P=0.036). Thirty chronic pain patients reported restrictions. The main disabilities were for the recreation, occupation and sexual subscale. Their PDI scores were not influenced whether work was rated as light or heavy (P=0.570). Twelve patients without chronic pain reported impairment in daily life (mean PDI score 8.8+/-10.8).
The PDI is feasible in inguinal hernia repair and can be used as an adjuvant in pain measurement. It can identify patients still suffering postoperatively who might otherwise be missed. Furthermore, the PDI could serve as a predictor for chronic pain.
在腹股沟疝修补术研究中，慢性疼痛是常用的主要终点指标。然而，其对日常生活活动的影响却较少得到研究。这样的结果对患者和外科医生都很重要，且无法从疼痛评分中推断得出。疼痛残疾指数（PDI）是一种让患者对自身功能障碍进行评分的问卷，它可以揭示疼痛的后果。因此，在一项基于开放补片的腹股沟疝修补术试验中引入了PDI。
共有172例患者接受了开放腹膜前修补术或Lichtenstein手术。本报告的主要终点指标是术前、术后2周和3个月时测量的PDI评分。同时评估视觉模拟量表疼痛（VAS）评分。慢性疼痛定义为术后3个月时的任何VAS评分。
146例患者（85%）有各个测量时间点的PDI评分。在所有时间点均发现PDI与VAS评分之间存在相关性（P<0.001）。共有47例患者报告有慢性疼痛。术后2周时，他们疼痛的强度与PDI的相关性比与VAS评分的相关性更显著（R=0.286，P<0.001；对比R=0.175，P=0.036）。30例慢性疼痛患者报告有功能受限。主要的功能障碍存在于娱乐、职业和性方面的子量表。他们的PDI评分不受工作被评定为轻或重的影响（P=0.570）。12例无慢性疼痛的患者报告有日常生活功能障碍（平均PDI评分为8.8±10.8）。
PDI在腹股沟疝修补术中是可行的，可作为疼痛测量的辅助手段。它可以识别术后仍有痛苦但可能被遗漏的患者。此外，PDI可作为慢性疼痛的预测指标。
