Erlenwein Joachim, Przemeck Michael, Degenhart Astrid, Budde Stefan, Falla Deborah, Quintel Michael, Pfingsten Michael, Petzke Frank
Pain Clinic, Department of Anesthesiology, University Hospital, Georg-August-University of Göttingen, Göttingen, Germany.
Department of Anesthesiology and Intensive Care, Annastift, Hannover, Germany.
J Pain. 2016 Feb;17(2):236-47. doi: 10.1016/j.jpain.2015.10.013. Epub 2015 Nov 5.
Pre-existing or chronic pain is an established risk factor for severe postoperative pain. In this prospective observational cohort study, we investigated whether a history of chronic pain, beyond the presence of hip-related pain, affected other postoperative factors including early mobilization, function, and psychological distress after hip surgery. Patients who underwent total hip replacement surgery were observed from the preoperative day until the seventh postoperative day. Before surgery, they were characterized by their pain history, pain intensity, function, and psychological characteristics. Postoperatively, pain intensity was evaluated on day 1, 3, 5, and 7 and the analgesic consumption was recorded for each of these days. Measures of function (functional questionnaire, ability to mobilize and to climb stairs, and range of hip motion) and psychological distress were re-evaluated on day 7. A history of chronic pain was associated with slower postoperative mobilization, poorer physical function, and greater psychological distress in addition to increased postoperative pain intensity. The comorbidity of a chronic pain disorder resulted in greater pain intensity after surgery, and also impeded postoperative rehabilitation. Identification of patients with a chronic pain disorder is necessary preoperatively so that appropriate pain management and rehabilitation can be planned to facilitate recovery.
Chronic pain, beyond the presence of hip-related pain, is associated with slower postoperative mobilization, poorer physical function, and greater psychological distress after total hip replacement surgery. Identification of patients with chronic pain and establishment of multiprofessional perioperative management might improve postoperative rehabilitation of patients with chronic pain.
既往存在的或慢性疼痛是严重术后疼痛的既定风险因素。在这项前瞻性观察队列研究中，我们调查了慢性疼痛史（除髋部相关疼痛外）是否会影响髋部手术后的其他术后因素，包括早期活动、功能及心理困扰。对接受全髋关节置换手术的患者从术前直至术后第7天进行观察。手术前，根据患者的疼痛史、疼痛强度、功能及心理特征对其进行特征描述。术后，在第1、3、5和7天评估疼痛强度，并记录这些日子里每天的镇痛药物消耗量。在第7天重新评估功能指标（功能问卷、活动及爬楼梯能力、髋关节活动范围）和心理困扰情况。慢性疼痛史除了会导致术后疼痛强度增加外，还与术后活动较慢、身体功能较差及心理困扰更大有关。慢性疼痛疾病的合并症导致术后疼痛强度更大，还会阻碍术后康复。术前识别患有慢性疼痛疾病的患者很有必要，以便能够制定适当的疼痛管理和康复计划以促进恢复。
除髋部相关疼痛外，慢性疼痛与全髋关节置换术后活动较慢、身体功能较差及心理困扰更大有关。识别慢性疼痛患者并建立多专业围手术期管理可能会改善慢性疼痛患者的术后康复情况。
