Department of Anesthesiology and Pain Treatment, Maastricht University Medical Center, Maastricht, The Netherlands.
Clin J Pain. 2012 Nov-Dec;28(9):819-41. doi: 10.1097/AJP.0b013e31824549d6.
Anxiety and pain catastrophizing predict acute postoperative pain. However, it is not well established whether they also predict chronic postsurgical pain (CPSP). The aim of this systematic review and meta-analysis was to investigate whether high levels of preoperative anxiety or pain catastrophizing are associated with an increased risk of CPSP.
Electronic search databases included PubMed and PsychINFO. Additional literature was obtained by reference tracking and expert consultation. Studies from 1958 until October 2010, investigating the association between preoperative anxiety or pain catastrophizing and CPSP in adult surgery patients, were assessed. The primary outcome was the presence of pain at least 3 months postoperatively.
Twenty-nine studies were included; 14 instruments were used to assess anxiety or pain catastrophizing. Sixteen studies (55%) reported a statistically significant association between anxiety or pain catastrophizing and CPSP. The proportion of studies reporting a statistically significant association was 67% for studies of musculoskeletal surgery and 36% for other types of surgery. There was no association with study quality, but larger studies were more likely to report a statistically significant relationship. The overall pooled odds ratio, on the basis of 15 studies, ranged from 1.55 (95% confidence interval, 1.10-2.20) to 2.10 (95% confidence interval, 1.49-2.95). Pain catastrophizing might be of higher predictive utility compared with general anxiety or more specific pain-related anxiety.
There is evidence that anxiety and catastrophizing play a role in the development of CPSP. We recommend that anxiety measures should be incorporated in future studies investigating the prediction and transition from acute to chronic postoperative pain.
焦虑和疼痛灾难化预测急性术后疼痛。然而，目前尚不清楚它们是否也能预测慢性术后疼痛（CPSP）。本系统评价和荟萃分析的目的是研究术前高水平的焦虑或疼痛灾难化是否与 CPSP 的风险增加有关。
电子检索数据库包括 PubMed 和 PsychINFO。通过参考文献追踪和专家咨询获得了额外的文献。评估了 1958 年至 2010 年 10 月期间，调查成年手术患者术前焦虑或疼痛灾难化与 CPSP 之间关联的研究。主要结局是术后至少 3 个月存在疼痛。
共纳入 29 项研究；使用了 14 种工具来评估焦虑或疼痛灾难化。16 项研究（55%）报告了焦虑或疼痛灾难化与 CPSP 之间存在统计学显著关联。报告统计学显著关联的研究比例为肌肉骨骼手术研究的 67%和其他类型手术研究的 36%。与研究质量无关，但较大的研究更有可能报告统计学显著的关系。基于 15 项研究的总体汇总优势比范围为 1.55（95%置信区间，1.10-2.20）至 2.10（95%置信区间，1.49-2.95）。与一般焦虑或更具体的与疼痛相关的焦虑相比，疼痛灾难化可能具有更高的预测效用。
有证据表明焦虑和灾难化在 CPSP 的发展中起作用。我们建议在未来研究中应将焦虑测量纳入急性到慢性术后疼痛的预测和转化研究。
