Nelson Jonas A, Fischer John P, Pasick Christina, Nelson Priscilla, Chen Alexander J, Fosnot Joshua, Selber Jesse C, Wu Liza C, Serletti Joseph M
Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
Ann Plast Surg. 2013 Sep;71(3):278-82. doi: 10.1097/SAP.0b013e31828637ec.
Chronic pain after breast reconstruction is an ill-defined process which can generate significant patient morbidity and disability. The purpose of this study was to examine chronic, persistent pain in a prospective study of free flap breast reconstruction patients, in an effort to identify possible points of intervention and counseling.
We performed a prospective study evaluating function, quality of life, and satisfaction in patients undergoing abdominally based autologous reconstruction between 2006 and 2010. Using the short form 36, we examined the presence of chronic body pain (>4 months) as well as overall mental and physical health. Patients with debilitating pain were compared to those without in a post hoc analysis.
Overall, 399 women underwent reconstruction during the study period, with 149 enrolling and having long-term follow-up in this portion of the prospective study. Twenty-six (17%) of 149 patients experienced chronic body pain that was moderately debilitating after autologous reconstruction, making it one of the most common complications experienced in this cohort. No differences were noted in demographics, medical history, procedure type, history of axillary surgery, radiation treatment, surgical outcomes, or follow-up time between the cohorts. However, patients with chronic pain were found to have higher preoperative pain scores (P < 0.0001) and lower physical, mental, and overall health scores across time points. All scores significantly worsened with time in comparison to the cohort without pain, who, in contrast showed score improvement across all areas. Although pain issues trended toward being noted in postoperative visits more frequently in the chronic pain cohort (37% vs 19%, P = 0.051), only 1 (4.2%) patient was referred for pain service consultation. Additionally, satisfaction with reconstruction was significantly lower in patients who demonstrated chronic pain (P = 0.03).
Factors contributing to chronic pain continue to be elusive and understudied. Our data demonstrate the importance of screening for chronic pain, as we determined that preoperative pain is linked to increased, moderately debilitating postoperative chronic pain. Persistent chronic pain, in turn, is associated with significant morbidity, disability, and dissatisfaction. Such patients with pain issues may benefit from additional preoperative counseling and early involvement of the pain service.
乳房重建术后的慢性疼痛是一个定义不明确的过程，可导致患者出现明显的发病和残疾。本研究的目的是在一项关于游离皮瓣乳房重建患者的前瞻性研究中，检查慢性持续性疼痛，以确定可能的干预和咨询要点。
我们进行了一项前瞻性研究，评估2006年至2010年间接受腹部自体组织重建患者的功能、生活质量和满意度。使用简短健康调查问卷（SF-36），我们检查了慢性身体疼痛（>4个月）的存在情况以及整体心理和身体健康状况。在事后分析中，将有严重疼痛的患者与无严重疼痛的患者进行比较。
总体而言，在研究期间有399名女性接受了重建手术，其中149名在前瞻性研究的这一部分中登记并接受了长期随访。149名患者中有26名（17%）在自体组织重建后经历了中度致残的慢性身体疼痛，这使其成为该队列中最常见的并发症之一。两组在人口统计学、病史、手术类型、腋窝手术史、放射治疗、手术结果或随访时间方面均未发现差异。然而，发现有慢性疼痛的患者术前疼痛评分较高（P<0.0001），且在各个时间点的身体、心理和整体健康评分较低。与无疼痛的队列相比，所有评分随时间均显著恶化，而无疼痛队列在所有领域的评分均有所改善。尽管慢性疼痛队列在术后随访中更频繁地出现疼痛问题（37%对19%，P=0.051），但只有1名（4.2%）患者被转诊至疼痛服务咨询。此外，出现慢性疼痛的患者对重建的满意度显著较低（P=0.03）。
导致慢性疼痛的因素仍然难以捉摸且研究不足。我们的数据证明了筛查慢性疼痛的重要性，因为我们确定术前疼痛与术后中度致残的慢性疼痛增加有关。反过来，持续性慢性疼痛与显著的发病、残疾和不满相关。这类有疼痛问题的患者可能会从额外的术前咨询和疼痛服务的早期介入中受益。
