Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen's University, Kingston, ON, Canada.
Clin J Pain. 2013 Jan;29(1):2-8. doi: 10.1097/AJP.0b013e31824730c2.
Many studies have reported putative factors for the development of chronic pain after surgery. However, advances in knowledge about the etiology and prognosis of chronic postsurgical pain (CPSP) could be gained by improving methodology within studies of surgical pain. The purpose of this study was to review predictive factors and to propose core risk factor and outcome domains for inclusion in future epidemiological studies investigating CPSP.
Using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials as a framework we reviewed risk factor and outcome domains, methodological issues and standardized measurement tools based on findings from narrative and systematic reviews, primary clinical and epidemiological studies and published guidelines for chronic pain clinical trials.
Five "core" risk factor domains (demographic, pain, clinical, surgery-related, and psychological) and 4 outcome domains (pain, physical functioning, psychological functioning, and global ratings of outcome) were identified. Important methodological issues, related to the definition and timing of follow-up to assess transition from acute to chronic pain are discussed. We also propose the use of validated, standardized measurement tools to capture risk factor and outcome domains at multiple time points.
There is potential to advance the field of CPSP research by striving for consensus among pain experts; this would advance current evidence by improving our ability to compare findings from different studies and would facilitate the aggregation of surgical cohort datasets to allow international comparisons. We propose these findings as a starting point to build a comprehensive framework for epidemiological studies investigating chronic pain after surgery.
许多研究报告了手术后慢性疼痛发展的推测因素。然而，通过改进手术疼痛研究中的方法学，可以更好地了解慢性手术后疼痛（CPSP）的病因和预后。本研究旨在回顾预测因素，并提出核心风险因素和结局领域，以纳入未来研究 CPSP 的流行病学研究。
我们使用临床试验中的方法、测量和疼痛评估倡议（Initiative on Methods，Measurement，and Pain Assessment in Clinical Trials）作为框架，根据叙事和系统评价、主要临床和流行病学研究以及慢性疼痛临床试验的出版指南中的发现，审查了风险因素和结局领域、方法学问题和标准化测量工具。
确定了五个“核心”风险因素领域（人口统计学、疼痛、临床、手术相关和心理）和四个结局领域（疼痛、身体功能、心理功能和总体结局评定）。讨论了与评估从急性到慢性疼痛的转变的随访的定义和时间相关的重要方法学问题。我们还建议使用经过验证的标准化测量工具在多个时间点捕获风险因素和结局领域。
通过努力在疼痛专家中达成共识，可以推动 CPSP 研究领域的发展；这将通过提高我们比较不同研究结果的能力来提高当前证据，并促进外科队列数据集的汇总，以允许国际比较。我们提出这些发现作为建立全面框架的起点，以调查手术后慢性疼痛的流行病学研究。
