Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of BioMedical Research, University of Bern, Bern, Switzerland.
Pain. 2019 Aug;160(8):1856-1865. doi: 10.1097/j.pain.0000000000001560.
Although chronic postsurgical pain (CPSP) is a major health care problem, pain-related functional interference has rarely been investigated. Using the PAIN OUT registry, we evaluated patients' pain-related outcomes on the first postoperative day, and their pain-related interference with daily living (Brief Pain Inventory) and neuropathic symptoms (DN4: douleur neuropathique en 4 questions) at 6 months after surgery. Endpoints were pain interference total scores (PITS) and their association with pain and DN4 scores. Furthermore, possible risk factors associated with impaired function at M6 were analyzed by ordinal regression analysis with PITS groups (no to mild, moderate, and severe interference) as a dependent three-stage factor. Odds ratios with 95% confidence intervals were calculated. Of 2322 patients, 15.3% reported CPSP with an average pain score ≥3 (numeric rating scale 0-10). Risk for a higher PITS group increased by 190% (odds ratio [95% confidence interval]: 2.9 [2.7-3.2]; P < 0.001) in patients with CPSP, compared to without CPSP. A positive DN4 independently increased risk by 29% (1.3 [1.12-1.45]; P < 0.001). Preexisting chronic pain (3.6 [2.6-5.1]; P < 0.001), time spent in severe acute pain (2.9 [1.3-6.4]; P = 0.008), neurosurgical back surgery in males (3.6 [1.7-7.6]; P < 0.001), and orthopedic surgery in females (1.7 [1.0-3.0]; P = 0.036) were the variables with strongest association with PITS. Pain interference total scores might provide more precise information about patients' outcomes than pain scores only. Because neuropathic symptoms increase PITS, a suitable instrument for their routine assessment should be defined.
尽管慢性术后疼痛（CPSP）是一个主要的医疗保健问题，但很少有研究调查与疼痛相关的功能障碍。我们使用 PAIN OUT 注册中心，评估了患者术后第一天的疼痛相关结果，以及术后 6 个月时他们的日常生活中疼痛相关干扰（简明疼痛量表）和神经病理性症状（DN4：4 个问题的神经病理性疼痛）。终点是疼痛干扰总评分（PITS）及其与疼痛和 DN4 评分的关系。此外，通过有序回归分析，使用 PITS 组（无到轻度、中度和重度干扰）作为依赖的三阶段因素，分析了与 M6 时功能受损相关的可能风险因素。计算了 95%置信区间的比值比。在 2322 名患者中，15.3%报告有 CPSP，平均疼痛评分≥3（数字评分量表 0-10）。与无 CPSP 患者相比，CPSP 患者的 PITS 较高组的风险增加了 190%（比值比[95%置信区间]：2.9[2.7-3.2]；P<0.001）。DN4 阳性独立增加了 29%的风险（1.3[1.12-1.45]；P<0.001）。预先存在的慢性疼痛（3.6[2.6-5.1]；P<0.001）、严重急性疼痛持续时间（2.9[1.3-6.4]；P=0.008）、男性神经外科背部手术（3.6[1.7-7.6]；P<0.001）和女性骨科手术（1.7[1.0-3.0]；P=0.036）是与 PITS 关联最强的变量。疼痛干扰总评分可能比疼痛评分提供更准确的患者结果信息。因为神经病理性症状增加了 PITS，所以应该定义一种用于常规评估的合适工具。
