Nishimura D, Kosugi S, Onishi Y, Ihara N, Wakaizumi K, Nagata H, Yamada T, Suzuki T, Hashiguchi S, Morisaki H
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
Eur J Pain. 2017 Aug;21(7):1144-1153. doi: 10.1002/ejp.1014. Epub 2017 Feb 7.
This prospective study was designed to examine the associations of demographic, clinical, psychological and neuroendocrine factors with acute and chronic post-operative pain following partial mastectomy.
Sixty-four female patients scheduled for partial mastectomy were enrolled. Pre-operative anxiety/depression was assessed, using the Hospital Anxiety and Depression Scale (HADS). Pre-operative 24-h urinary cortisol levels were measured 2 days before surgery. Post-operative pain was examined using a visual analog scale (VAS) for acute pain on 0-2 post-operative day (POD), and a short-form McGill Pain Questionnaire for chronic pain at 6 months after surgery. In the last 29 subjects, post-operative 24-h urinary cortisol levels were also measured on 0 POD and were subjected to correlation analysis.
Multivariate logistic regression analysis revealed that lower pre-operative cortisol secretion and greater pre-operative anxiety were significantly associated with an increased risk of moderate to severe acute post-operative pain [Odds Ratio (95% Confidence Interval); 0.96 (0.92-0.98), and 1.24 (1.04-1.54)], and that patients with greater pre-operative anxiety and moderate to severe acute pain were more likely to develop chronic post-operative pain [OR (95% CI); 1.63 (1.23-2.40), and 5.07 (1.30-24.6)]. Correlational analysis demonstrated that the post-operative cortisol level was inversely correlated with pre-operative anxiety and the intensity of acute post-operative pain (r = -0.40, p < 0.05, and r = -0.50, p < 0.01), but not with the intensity of chronic pain.
This study confirms that pre-operative anxiety is associated with both acute and chronic post-operative pain after partial mastectomy. It also suggests that lower perioperative cortisol secretion might be associated with greater acute post-operative pain.
Although the associations between psychological stress/stress hormone levels and chronic post-operative pain remain to be determined, pre-operative psychological stress and perioperative cortisol levels are correlated with acute post-operative pain.
本前瞻性研究旨在探讨人口统计学、临床、心理和神经内分泌因素与部分乳房切除术后急性和慢性疼痛的相关性。
纳入64例计划接受部分乳房切除术的女性患者。使用医院焦虑抑郁量表（HADS）评估术前焦虑/抑郁情况。术前2天测量术前24小时尿皮质醇水平。术后疼痛采用视觉模拟量表（VAS）评估术后0至2天的急性疼痛，采用简式麦吉尔疼痛问卷评估术后6个月的慢性疼痛。在最后29名受试者中，还在术后第0天测量了术后24小时尿皮质醇水平，并进行相关性分析。
多因素逻辑回归分析显示，术前皮质醇分泌较低和术前焦虑程度较高与中度至重度术后急性疼痛风险增加显著相关[比值比（95%置信区间）；0.96（0.92 - 0.98）和1.24（1.04 - 1.54）]，术前焦虑程度较高且有中度至重度急性疼痛的患者更易发生术后慢性疼痛[比值比（95%置信区间）；1.63（1.23 - 2.40）和5.07（1.30 - 24.6）]。相关性分析表明，术后皮质醇水平与术前焦虑及术后急性疼痛强度呈负相关（r = -0.40，p < 0.05，r = -0.50，p < 0.01），但与慢性疼痛强度无关。
本研究证实术前焦虑与部分乳房切除术后急性和慢性疼痛均相关。还表明围手术期皮质醇分泌较低可能与术后急性疼痛加剧有关。
尽管心理应激/应激激素水平与术后慢性疼痛之间的关联尚待确定，但术前心理应激和围手术期皮质醇水平与术后急性疼痛相关。
