Department of Psychology, University of Calgary, Calgary, AB, Canada.
Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Pain. 2019 Aug;160(8):1729-1739. doi: 10.1097/j.pain.0000000000001582.
Children who develop greater negatively-biased recall of pain (ie, recalled pain is higher than the initial pain report) following surgery are at risk for developing chronic pain; therefore, identifying risk factors for the development of biased pain memories is important. Higher anxiety has been implicated in the development of greater negatively-biased recall of pain; however, studies have not examined anxiety at multiple time points before and after a surgery and its relationship to children's postsurgical pain memories after 1 year. This prospective study examined a cohort of 237 children and adolescents undergoing major surgery. Anxiety sensitivity, pain catastrophizing, and pain anxiety were assessed at baseline, 48 to 72 hours after surgery, and at 6- and 12-month follow-ups. Pain intensity at rest, movement-evoked pain intensity, and pain unpleasantness were assessed daily in hospital. Memories for pain were elicited via telephone 1-year post surgery. Findings revealed that children who had higher levels of anxiety at baseline and 48 to 72 hours after surgery developed greater negatively-biased recall of pain intensity 12 months after surgery. Specifically, higher anxiety sensitivity at baseline and greater tendencies to catastrophize about pain at baseline and in the immediate acute recovery phase were most strongly linked to greater negatively-biased recall of pain. Greater negatively-biased recall of pain was related to higher pain intensity at 6 and 12 months post surgery. Findings support conceptual models of anxiety and pain memory biases and can inform intervention efforts to reduce anxiety in the pre- and post-op periods to minimize negative biases in pain memories.
术后对疼痛产生更大负性记忆偏差（即，回忆的疼痛高于初始疼痛报告）的儿童有发生慢性疼痛的风险；因此，确定产生偏向性疼痛记忆的风险因素很重要。较高的焦虑与更大的负性记忆偏差有关；然而，研究尚未在手术前后多个时间点检查焦虑，并研究其与术后 1 年儿童术后疼痛记忆的关系。这项前瞻性研究对 237 名接受大手术的儿童和青少年进行了研究。在基线、手术后 48 至 72 小时以及术后 6 至 12 个月进行了焦虑敏感性、疼痛灾难化和疼痛焦虑评估。在医院每天评估休息时的疼痛强度、运动诱发的疼痛强度和疼痛不适。在术后 1 年通过电话引出疼痛记忆。研究结果表明，基线和术后 48 至 72 小时焦虑水平较高的儿童在术后 12 个月时对疼痛强度的负性记忆偏差更大。具体而言，基线时较高的焦虑敏感性和更大的对疼痛灾难化的倾向，以及在基线和急性恢复期，与更大的负性记忆偏差最相关。对疼痛的负性记忆偏差越大，术后 6 个月和 12 个月时的疼痛强度越高。研究结果支持焦虑和疼痛记忆偏差的概念模型，并为干预措施提供信息，以减少手术前后的焦虑，最大限度地减少疼痛记忆中的负性偏差。
