Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
Pain. 2018 May;159(5):956-967. doi: 10.1097/j.pain.0000000000001170.
Chronic postsurgical pain (CPSP) is a well-recognized potential complication with negative personal, social, and health care consequences. However, limited data exist on CPSP and on the course of pain over time after hysterectomy. Using data from a prospective cohort study on a consecutive sample assessed at 4 time points, presurgery (T1), 48 hours (T2), 4 months (T3), and 5 years postsurgery (T4), we sought to examine women's PSP trajectories using assessments of pain at T3 and T4. In addition, this study aimed to investigate presurgical and postsurgical risk factors associated with an unfavourable pain trajectory (PT). Based on pain data collected at T3 and T4, 3 distinct trajectories of PSP emerged: no CPSP (PT1; n = 88), prolonged PSP (PT2; n = 53), and CPSP (PT3; n = 29). Moreover, reported CPSP prevalence at 5 years was 17.1%. Multinomial logistic regression models controlling for age, presurgical pain, and type of hysterectomy tested for baseline and acute postsurgical predictive variables. Membership in PT2 and PT3 was predicted by presurgical anxiety (odds ratio [OR] = 1.131, P = 0.015; OR = 1.175, P = 0.009, respectively), emotional representation of the surgical disease (OR = 1.155, P = 0.034; OR = 1.213, P = 0.020, respectively), and pain catastrophizing (OR = 1.079, P = 0.043; OR = 1.143, P = 0.001, respectively). Furthermore, acute PSP intensity and frequency determined membership of women in PT3 (OR = 1.211, P = 0.033; OR = 3.000, P = 0.029, respectively), and postsurgical anxiety (OR = 1.182, P = 0.026) also played a key predictive role. This study identified factors that can be easily screened before and after surgery and are amenable to change through carefully designed timely and tailored interventions for women at risk of an unfavorable PSP trajectory posthysterectomy.
慢性术后疼痛 (CPSP) 是一种公认的潜在并发症，会对个人、社会和医疗保健产生负面影响。然而，关于 CPSP 以及子宫切除术后疼痛随时间的变化过程，数据有限。本研究使用前瞻性队列研究的连续样本数据，在 4 个时间点进行评估，分别为术前 (T1)、48 小时 (T2)、4 个月 (T3) 和术后 5 年 (T4)，旨在通过 T3 和 T4 的疼痛评估来研究女性 PSP 的轨迹。此外，本研究旨在调查与不良疼痛轨迹 (PT) 相关的术前和术后风险因素。基于 T3 和 T4 收集的疼痛数据，出现了 3 种不同的 PSP 轨迹：无 CPSP (PT1；n=88)、持续性 PSP (PT2；n=53) 和 CPSP (PT3；n=29)。此外，5 年后报告的 CPSP 患病率为 17.1%。多元逻辑回归模型控制年龄、术前疼痛和子宫切除术类型，测试基线和急性术后预测变量。PT2 和 PT3 的成员资格由术前焦虑 (比值比 [OR] = 1.131，P = 0.015；OR = 1.175，P = 0.009)、手术疾病的情绪表达 (OR = 1.155，P = 0.034；OR = 1.213，P = 0.020) 和疼痛灾难化 (OR = 1.079，P = 0.043；OR = 1.143，P = 0.001) 预测。此外，急性 PSP 强度和频率决定了妇女在 PT3 中的成员资格 (OR = 1.211，P = 0.033；OR = 3.000，P = 0.029)，术后焦虑 (OR = 1.182，P = 0.026) 也发挥了关键预测作用。本研究确定了可以在术前和术后轻松筛查的因素，并可以通过针对子宫切除术后有不良 PSP 轨迹风险的女性进行精心设计的及时和定制的干预措施来改变这些因素。
