Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany.
Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Germany.
Eur J Pain. 2018 Feb;22(2):402-413. doi: 10.1002/ejp.1129. Epub 2017 Nov 5.
There is growing evidence for the development of chronic pain after intensive care. Nonetheless, there is only limited knowledge about factors leading to chronic intensive care-related pain (CIRP). Thus, the primary objective was the identification of predictors of CIRP. Moreover, we aimed to assess the impact of CIRP on patients' health-related quality of Life (HRQOL).
Comprehensive information on patients' pain before ICU admission and present pain was collected longitudinally by means of the German Pain Questionnaire 6 and 12 months after ICU discharge (ICU ). In addition, a subsample of patients underwent Quantitative Sensory Testing (QST). We used Generalized Estimating Equations to identify predictors of CIRP with logistic regression models.
In total, 204 patients (197/159 at 6/12 months after ICU ) were available for the analyses. In the multivariate models, moderate to severe average pain in the 4 weeks after ICU , lower age, female sex, increased inflammation and chronic pain conditions and increased levels of anxiety before ICU admission were predictive for CIRP. In addition, small fibre deficits and lower disease severity were associated with CIRP in the QST subsample (81 patients, 77/55 at 6/12 months after ICU ). Patients with CIRP reported significantly lower HRQOL than patients without CIRP.
Chronic intensive care-related pain is associated with specific decrements in HRQOL. Knowledge about the identified predictors is of clinical and scientific importance and might help to reduce the incidence of CIRP.
Chronic intensive care-related pain is associated with specific decrements in health-related quality of life. While most of the identified predictors for CIRP can only be considered as risk factors, especially adequate (post-) acute pain management should be studied as preventive strategy.
越来越多的证据表明，重症监护后会发展为慢性疼痛。尽管如此，对于导致慢性重症监护相关性疼痛（CIRP）的因素知之甚少。因此，主要目的是确定 CIRP 的预测因素。此外，我们旨在评估 CIRP 对患者健康相关生活质量（HRQOL）的影响。
通过德国疼痛问卷 6 项和 12 个月后 ICU 出院时（ICU ），纵向收集患者 ICU 入院前和当前疼痛的综合信息。此外，对患者进行了定量感觉测试（QST）。我们使用广义估计方程（GEE）通过逻辑回归模型确定 CIRP 的预测因素。
共有 204 名患者（197/159 名患者在 ICU 后 6/12 个月）可用于分析。在多变量模型中，ICU 后 4 周内中度至重度平均疼痛、年龄较小、女性、炎症和慢性疼痛状态增加以及 ICU 入院前焦虑水平升高是 CIRP 的预测因素。此外，在 QST 亚组中（81 名患者，77/55 名患者在 ICU 后 6/12 个月），小纤维缺陷和疾病严重程度降低与 CIRP 相关。患有 CIRP 的患者报告的 HRQOL 明显低于没有 CIRP 的患者。
慢性重症监护相关性疼痛与 HRQOL 的特定下降有关。对确定的预测因素的了解具有临床和科学意义，并可能有助于降低 CIRP 的发生率。
慢性重症监护相关性疼痛与健康相关生活质量的特定下降有关。虽然大多数 CIRP 的预测因素只能被认为是风险因素，但特别是应将适当的（急性后期）疼痛管理作为预防策略进行研究。
