Department of Orthopedic Surgery and Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East-South Tower, Suite 4200, Nashville, TN 37232, USA.
J Trauma Acute Care Surg. 2012 Apr;72(4):1068-77. doi: 10.1097/TA.0b013e3182452df5.
Unmanaged pain has been found to predict delayed return to work, psychologic distress, and chronic pain and disability in patients with traumatic injury. However, little is known about the pain experience during hospitalization. The primary objective of this study was to determine pain intensity, pain interference, and satisfaction with pain treatment in orthopedic trauma patients at hospital discharge. A secondary objective was to examine whether patient self-efficacy and psychologic distress were associated with pain and satisfaction.
Two hundred thirty-three orthopedic trauma patients were enrolled and completed a discharge assessment at a Level I trauma center. Pain was measured with the Brief Pain Inventory and satisfaction with the American Pain Society Patient Outcome Questionnaire.
Ninety-seven percent of patients reported pain at the time of hospital discharge, with 59% and 73% reporting moderate to severe pain intensity and interference, respectively. Overall, 86% of patients were satisfied with pain treatment. Multivariable regression analyses demonstrated that decreased self-efficacy was associated with moderate to severe pain intensity, increased depression was associated with moderate to severe pain intensity and interference, and increased pain intensity was associated with decreased satisfaction (p < 0.05).
Results suggest that orthopedic trauma patients have a significant pain burden but are satisfied with pain treatment during the hospital stay. Efforts are needed to improve pain assessment and management and findings imply that addressing self-efficacy and depressive symptoms may decrease pain and increase satisfaction at hospital discharge. Brief educational interventions that incorporate pain coping skills and self-management techniques may be a feasible approach to improving self-efficacy in the acute care setting. Additional recommendations include routine hospital screening for depression and increased communication between surgeons and mental health providers to identify patients at high risk for unmanaged pain and facilitate provision of early mental health services.
研究发现，未得到控制的疼痛可预测创伤患者延迟重返工作岗位、心理困扰、慢性疼痛和残疾。然而，人们对住院期间的疼痛体验知之甚少。本研究的主要目的是确定骨科创伤患者出院时的疼痛强度、疼痛干扰和对疼痛治疗的满意度。次要目的是检查患者自我效能和心理困扰是否与疼痛和满意度相关。
在一家一级创伤中心，纳入 233 名骨科创伤患者，并在出院时完成评估。疼痛使用简明疼痛量表（Brief Pain Inventory）和美国疼痛协会患者结局问卷（American Pain Society Patient Outcome Questionnaire）进行测量。
97%的患者在出院时报告有疼痛，59%和 73%分别报告有中度至重度疼痛强度和干扰。总体而言，86%的患者对疼痛治疗感到满意。多变量回归分析表明，自我效能降低与中度至重度疼痛强度相关，抑郁增加与中度至重度疼痛强度和干扰相关，疼痛强度增加与满意度降低相关（p<0.05）。
结果表明，骨科创伤患者的疼痛负担显著，但对住院期间的疼痛治疗感到满意。需要努力改善疼痛评估和管理，研究结果表明，解决自我效能和抑郁症状可能会降低疼痛并提高出院时的满意度。在急性护理环境中，采用包含疼痛应对技巧和自我管理技术的简短教育干预可能是提高自我效能的可行方法。其他建议包括常规的医院抑郁筛查以及增加外科医生和精神卫生提供者之间的沟通，以识别未得到控制的疼痛风险较高的患者，并促进早期心理健康服务的提供。
