Pierik J G J, IJzerman M J, Gaakeer M I, Vollenbroek-Hutten M M R, van Vugt A B, Doggen C J M
Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Emergency Department, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands.
Eur J Pain. 2016 May;20(5):711-22. doi: 10.1002/ejp.796. Epub 2015 Oct 22.
Chronic pain in patients is usually related to an episode of pain following acute injury, emphasizing the need to prevent progression from acute to chronic pain. Multiple factors in the acute phase might be responsible for perpetuating the pain. The presentation of patients at the emergency department (ED) presents a prime opportunity to identify patients at high risk for chronic pain and to start appropriate treatment.
The PROTACT study is a prospective follow-up study aiming to estimate the incidence and prognostic factors responsible for the development of chronic pain after musculoskeletal injury. Data including sociodemographic, pain, clinical, injury- or treatment-related and psychological factors of 435 patients were collected from registries and questionnaires at ED visit, 6-week, 3- and 6-month follow-up.
At 6 months post-injury, 43.9% of the patients had some degree of pain (Numeric Rating Scale (NRS) ≥1) and 10.1% had chronic pain (NRS ≥4). Patients aged over 40 years, in poor physical health, with pre-injury chronic pain, pain catastrophizing, high urgency level and severe pain at discharge were found to be at high risk for chronic pain.
Two prognostic factors, severe pain at discharge and pain catastrophizing, are potentially modifiable. The implementation of a pain protocol in the ED and the use of cognitive-behavioural techniques involving reducing catastrophizing might be useful.
患者的慢性疼痛通常与急性损伤后的疼痛发作有关,这凸显了预防疼痛从急性发展为慢性的必要性。急性期的多种因素可能导致疼痛持续存在。患者在急诊科就诊为识别慢性疼痛高危患者并开始适当治疗提供了绝佳机会。
PROTACT研究是一项前瞻性随访研究,旨在评估肌肉骨骼损伤后慢性疼痛的发生率及相关预后因素。在急诊科就诊时、6周、3个月和6个月随访时,通过登记处和问卷收集了435例患者的社会人口统计学、疼痛、临床、损伤或治疗相关及心理因素等数据。
受伤后6个月时,43.9%的患者有一定程度的疼痛(数字评定量表(NRS)≥1),10.1%的患者有慢性疼痛(NRS≥4)。研究发现,年龄超过40岁、身体健康状况差、受伤前有慢性疼痛、疼痛灾难化、紧迫性高以及出院时疼痛严重的患者慢性疼痛风险较高。
两个预后因素,即出院时的严重疼痛和疼痛灾难化,可能是可以改变的。在急诊科实施疼痛治疗方案以及采用包括减少灾难化在内的认知行为技术可能会有所帮助。