Anaesthesia and Pain Medicine, Plymouth University Hospitals NHS Trust, Plymouth, UK.
Clinical Trials and Medical Statistics, University of Plymouth, UK.
Anaesthesia. 2019 Jan;74(1):69-73. doi: 10.1111/anae.14476. Epub 2018 Oct 27.
The effect of patient-controlled analgesia during the emergency phase of care on the prevalence of persistent pain is unkown. We studied individuals with traumatic injuries or abdominal pain 6 months after hospital admission via the emergency department using an opportunistic observational study design. This was conducted using postal questionnaires that were sent to participants recruited to the multi-centre pain solutions in the emergency setting study. Patients with prior chronic pain states or opioid use were not studied. Questionnaires included the EQ5D, the Brief Pain Inventory and the Hospital Anxiety and Depression scale. Overall, 141 out of 286 (49% 95%CI 44-56%) patients were included in this follow-up study. Participants presenting with trauma were more likely to develop persistent pain than those presenting with abdominal pain, 45 out of 64 (70%) vs. 24 out of 77 (31%); 95%CI 24-54%, p < 0.001. There were no statistically significant associations between persistent pain and analgesic modality during hospital admission, age or sex. Across both abdominal pain and traumatic injury groups, participants with persistent pain had lower EQ5D mobility scores, worse overall health and higher anxiety and depression scores (p < 0.05). In the abdominal pain group, 13 out of 50 (26%) patients using patient-controlled analgesia developed persistent pain vs. 11 out of 27 (41%) of those with usual treatment; 95%CI for difference (control - patient-controlled analgesia) -8 to 39%, p = 0.183. Acute pain scores at the time of hospital admission were higher in participants who developed persistent pain; 95%CI 0.7-23.6, p = 0.039. For traumatic pain, 25 out of 35 (71%) patients given patient-controlled analgesia developed persistent pain vs. 20 out of 29 (69%) patients with usual treatment; 95%CI -30 to 24%, p = 0.830. Persistent pain is common 6 months after hospital admission, particularly following trauma. The study findings suggest that it may be possible to reduce persistent pain (at least in patients with abdominal pain) by delivering better acute pain management. Further research is needed to confirm this hypothesis.
在急诊护理的紧急阶段，患者自控镇痛对持续性疼痛的发生率的影响尚不清楚。我们使用机会性观察研究设计，在医院急诊部收治创伤或腹痛患者 6 个月后对其进行了研究。这项研究使用邮寄问卷进行，这些问卷被发送给多中心疼痛解决方案研究中招募的参与者。没有研究有慢性疼痛病史或使用阿片类药物的患者。问卷包括 EQ5D、简明疼痛量表和医院焦虑抑郁量表。共有 286 名患者中的 141 名（49%[95%CI 44-56%]）参与了这项随访研究。与腹痛患者相比，创伤患者发生持续性疼痛的可能性更高，64 名患者中有 45 名（70%）；77 名患者中有 24 名（31%）；95%CI 24-54%，p<0.001。在住院期间，接受镇痛的方式、年龄或性别与持续性疼痛之间没有统计学显著关联。在腹痛和创伤两组中，有持续性疼痛的参与者的 EQ5D 移动评分较低，整体健康状况较差，焦虑和抑郁评分较高（p<0.05）。在腹痛组中，50 名患者中有 13 名（26%）使用患者自控镇痛发生持续性疼痛，而 27 名患者中有 11 名（41%）接受常规治疗；95%CI（对照组-患者自控镇痛）差值为-8 至 39%，p=0.183。发生持续性疼痛的参与者在入院时的急性疼痛评分较高；95%CI 0.7-23.6，p=0.039。对于创伤性疼痛，35 名患者中有 25 名（71%）接受患者自控镇痛发生持续性疼痛，而 29 名患者中有 20 名（69%）接受常规治疗；95%CI-30 至 24%，p=0.830。住院 6 个月后，持续性疼痛很常见，尤其是在创伤后。研究结果表明，通过提供更好的急性疼痛管理，可能减少持续性疼痛（至少在腹痛患者中）。需要进一步研究来证实这一假设。
