Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
National Center for Complementary and Integrative Health, NIH, Bethesda, Maryland.
J Pain. 2020 Mar-Apr;21(3-4):294-305. doi: 10.1016/j.jpain.2019.08.008. Epub 2019 Sep 5.
Acute pain after breast surgery decreases the quality of life of cancer survivors. Previous studies using a variety of definitions and methods report prevalence rates between 10% and 80%, which suggests the need for a comprehensive framework that can be used to guide assessment of acute pain and pain-related outcomes after breast surgery. A multidisciplinary task force with clinical and research expertise performed a focused review and synthesis and applied the 5 dimensional framework of the AAAPT (Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks [ACTTION], American Academy of Pain Medicine [AAPM], American Pain Society [APS] Pain Taxonomy) to acute pain after breast surgery. Application of the AAAPT taxonomy yielded the following: 1) Core Criteria: Location, timing, severity, and impact of breast surgery pain were defined; 2) Common Features: Character and expected trajectories were established in relevant surgical subgroups, and common pain assessment tools for acute breast surgery pain identified; 3) Modulating Factors: Biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: Domains of impact were outlined and defined; 5) Neurobiologic Mechanisms: Putative mechanisms were specified ranging from nerve injury, inflammation, peripheral and central sensitization, to affective and social processing of pain. PERSPECTIVE: The AAAPT provides a framework to define and guide improved assessment of acute pain after breast surgery, which will enhance generalizability of results across studies and facilitate meta-analyses and studies of interindividual variation, and underlying mechanism. It will allow researchers and clinicians to better compare between treatments, across institutions, and with other types of acute pain.
乳腺癌手术后的急性疼痛会降低癌症幸存者的生活质量。之前的研究使用了各种不同的定义和方法，报告的发生率在 10%到 80%之间，这表明需要一个全面的框架来指导乳腺癌手术后急性疼痛和与疼痛相关的结局的评估。一个具有临床和研究专业知识的多学科工作组进行了重点审查和综合，并应用了 AAAPT（镇痛、麻醉和成瘾临床试验转化、创新、机会和网络[ACTTION]、美国疼痛医学学院[AAPM]、美国疼痛学会[APS]疼痛分类）的 5 个维度框架来评估乳腺癌手术后的急性疼痛。AAAPT 分类学的应用产生了以下结果：1）核心标准：定义了乳腺癌手术疼痛的位置、时间、严重程度和影响；2）常见特征：在相关手术亚组中建立了特征和预期轨迹，并确定了用于急性乳腺癌手术疼痛的常见疼痛评估工具；3）调节因素：描绘了调节个体间变异性的生物学、心理和社会因素；4）影响/功能后果：概述并定义了影响领域；5）神经生物学机制：指定了潜在的机制，从神经损伤、炎症、外周和中枢敏化到疼痛的情感和社会处理。观点：AAAPT 提供了一个定义和指导乳腺癌手术后急性疼痛评估的框架，这将提高研究结果在各研究之间的可推广性，并促进荟萃分析和个体间变异以及潜在机制的研究。它将使研究人员和临床医生能够更好地比较治疗方法、机构之间以及与其他类型的急性疼痛。
