* Senior Researcher, Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland; and Folkhälsan Institute of Genetics, Folkhälsan Research Center. † Associate Professor, ‡ Student, ** Clinical Psychologist, Department of Anaesthesia and Intensive Care Medicine, ‖ Consultant in Oncology, Department of Oncology, †† Associate Professor, Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. § Student, ‡‡ Professor, Institute for Molecular Medicine Finland, University of Helsinki. # Professor, Institute for Molecular Medicine Finland, University of Helsinki; and Department of Human Genetics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom. §§ Professor, Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Helsinki University Central Hospital, Helsinki; and Institute of Clinical Medicine, University of Helsinki.
Anesthesiology. 2013 Dec;119(6):1410-21. doi: 10.1097/ALN.0000000000000012.
This article describes the methods and results of the early part (experimental pain tests and postoperative analgesia) of a study that assesses genetic and other factors related to acute pain and persistent pain after treatment of breast cancer in a prospective cohort of 1,000 women.
One thousand consenting patients were recruited to the study. Before surgery (breast resection or mastectomy with axillary surgery), the patients filled in questionnaires about health, life style, depression (Beck Depression Inventory), and anxiety (State-Trait Anxiety Inventory). They were also exposed to experimental tests measuring heat (43° and 48°C, 5 s) and cold (2-4°C) pain intensity and tolerance. Anesthesia was standardized with propofol and remifentanil, and postoperative analgesia was optimized with i.v. oxycodone.
The patients showed significant interindividual variation in heat and cold pain sensitivity and cold pain tolerance. There was a strong correlation between the experimental pain measures across the tests. Presence of chronic pain, the number of previous operations, and particularly state anxiety were related to increased pain sensitivity. Previous smoking correlated with decreased heat pain sensitivity. These factors explained 4-5% of the total variance in pain sensitivity in these tests. Oxycodone consumption during 20 h was significantly higher in patients who had axillary clearance. Oxycodone consumption had only a weak correlation with the experimental pain measures.
Contact heat and cold pressure tests identify variability in pain sensitivity which is modified by factors such as anxiety, chronic pain, previous surgery, and smoking. High levels of anxiety are connected to increased pain sensitivity in experimental and acute postoperative pain.
本文描述了一项研究的早期部分（实验性疼痛测试和术后镇痛）的方法和结果，该研究评估了与乳腺癌治疗后急性疼痛和持续性疼痛相关的遗传和其他因素，研究对象为 1000 名女性的前瞻性队列。
本研究共招募了 1000 名同意参加的患者。在手术前（乳房切除术或乳房切除术加腋窝手术），患者填写了关于健康、生活方式、抑郁（贝克抑郁量表）和焦虑（状态-特质焦虑量表）的问卷。他们还接受了实验性测试，以测量热（43°C 和 48°C，5 秒）和冷（2-4°C）疼痛强度和耐受力。采用异丙酚和瑞芬太尼标准化麻醉，并优化静脉注射羟考酮进行术后镇痛。
患者在热和冷痛觉敏感性以及冷痛觉耐受力方面存在显著的个体间差异。实验性疼痛测量值之间存在很强的相关性。慢性疼痛的存在、既往手术次数，特别是状态焦虑与疼痛敏感性增加有关。既往吸烟与热痛觉敏感性降低有关。这些因素解释了这些测试中疼痛敏感性总方差的 4-5%。行腋窝清扫术的患者在 20 小时内消耗的羟考酮明显更高。羟考酮消耗量与实验性疼痛测量值只有微弱的相关性。
接触热和冷压力测试可识别疼痛敏感性的变异性，这种变异性受焦虑、慢性疼痛、既往手术和吸烟等因素的影响。高水平的焦虑与实验性和急性术后疼痛中的疼痛敏感性增加有关。
