Gerbershagen Hans J, Dagtekin Oguzhan, Rothe Tim, Heidenreich Axel, Gerbershagen Kathrin, Sabatowski Rainer, Petzke Frank, Ozgür Enver
Department of Anesthesiology, University of Cologne, Kerpenerstr. 62, 50924 Cologne, Germany.
Eur J Pain. 2009 Sep;13(8):853-60. doi: 10.1016/j.ejpain.2008.10.001. Epub 2008 Nov 14.
This longitudinal study was performed in order to analyze the incidence of and perioperative risk factors for the development of chronic postsurgical pain (CPSP) in patients after nephrectomy.
For baseline data acquisition, valid instruments were used for scoring sociodemographic, psychological, psychosocial, pain, pain treatment, and comorbidity factors: the Mainz Pain Staging System (MPSS) for pain chronicity, the Chronic Pain Grading Questionnaire (CPGQ), the Neuropathic Pain Scale (NPS), the Hospital Anxiety and Depression Scale (HADS), the Short Form 12 (SF-12) for health-related quality of life, the Habitual Well-Being Questionnaire (HWBQ), the Symptom Check List (SCL-8) for detecting psychosomatic dysfunction, and the Weighted Illness Check List (WICL) for evaluation of comorbidities and their impact on activities of daily living. Pain intensities were recorded over the first 6 postoperative days after nephrectomy. A sample of 35 patients was followed up for 3 and 6 months.
Patients with more intense postoperative pain during the first 6 days had significantly higher preoperative anxiety scores. The incidence of CPSP 3 and 6 months after nephrectomy was 28.6% and 8.6%, respectively. Preoperatively increased anxiety scores, reduced physical health-related quality of life (SF-12), multiple comorbid conditions, and increased comorbidity-related disability were significantly associated with the occurrence of CPSP after 3 months. These patients also reported more severe pain during the first week after surgery. Preoperative "current pain intensity" was significantly increased in CPSP patients.
Our results demonstrate a multifactorial development of CPSP. This process may contribute not only to the occurrence of chronic postsurgical pain but also to the biopsychosocial impairment in these patients as often seen in other chronic pain populations.
开展这项纵向研究是为了分析肾切除术后患者慢性术后疼痛（CPSP）的发生率及围手术期危险因素。
为获取基线数据，使用了有效的工具对社会人口统计学、心理、社会心理、疼痛、疼痛治疗及合并症因素进行评分：用于疼痛慢性化的美因茨疼痛分期系统（MPSS）、慢性疼痛分级问卷（CPGQ）、神经性疼痛量表（NPS）、医院焦虑抑郁量表（HADS）、用于健康相关生活质量的简明健康调查问卷（SF - 12）、习惯性幸福感问卷（HWBQ）、用于检测心身功能障碍的症状自评量表（SCL - 8）以及用于评估合并症及其对日常生活活动影响的加权疾病检查表（WICL）。在肾切除术后的前6天记录疼痛强度。对35例患者进行了3个月和6个月的随访。
术后前6天疼痛较剧烈的患者术前焦虑评分显著更高。肾切除术后3个月和6个月时CPSP的发生率分别为28.6%和8.6%。术前焦虑评分升高、与身体健康相关的生活质量（SF - 12）降低、多种合并症以及合并症相关残疾增加与3个月后CPSP的发生显著相关。这些患者在术后第一周也报告疼痛更严重。CPSP患者术前的“当前疼痛强度”显著升高。
我们的结果表明CPSP的发生是多因素的。这一过程不仅可能导致慢性术后疼痛的发生，还可能导致这些患者出现生物心理社会损害，这在其他慢性疼痛人群中也很常见。
