Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
Department of Pain Medicine, The Children's Hospital, Westmead, New South Wales, Australia.
Eur J Pain. 2020 Apr;24(4):722-741. doi: 10.1002/ejp.1539. Epub 2020 Feb 13.
The aim of this study was to investigate prognostic factors for pain and functional disability in children and/or adolescents with persisting pain.
To be included, studies had to be published, peer-reviewed prospective cohort studies of children and/or adolescents with persisting pain at baseline, that reported at least one baseline prognostic factor and its relationship with pain or functional disability at least 1 month after baseline. Two reviewers independently assessed study eligibility, completed data extraction and undertook quality assessment. Meta-analyses were performed when a prognostic factor was reported in two or more studies.
Of 10,992 studies identified from electronic database searches, 18 were included, investigating 62 potential prognostic factors. In clinical settings, insufficient data were available for meta-analysis. Some positive associations with pain and/or disability were reported by single studies for older age, baseline pain intensity and baseline functional disability across multiple combinations of follow-up times and outcomes. In community settings, meta-analyses of two studies found that prognostic factors for the ongoing presence of pain at medium-term (1-year) follow-up were older age (OR 1.25; 95% CI = 1.05-1.47), weekly day tiredness (OR 1.69; 95% CI = 1.14-2.51), weekly abdominal pain (OR 1.44; 95% CI = 1.03-2.02) and waking during the night (OR 1.49; 95% CI = 1.05-2.13). No studies in community settings reported on prognostic factors for functional disability.
Prognostic factors having significant associations with future pain and disability were identified; however, as few were investigated in more than one comparable study, the results need to be interpreted with caution.
Prognostic factors from across the biopsychosocial spectrum are important to consider in paediatric pain clinical practice. However, most prognostic factors that experts have previously agreed upon have not been assessed in prospective cohort studies to date. The findings may help with prioritising data to collect during clinical assessments of children presenting with pain, in the context of pain and functional disability outcomes.
本研究旨在探讨持续性疼痛患儿和/或青少年疼痛和功能障碍的预后因素。
纳入的研究必须是已发表的、同行评审的前瞻性队列研究，基线时有持续性疼痛的儿童和/或青少年，至少报告一个基线预后因素及其与基线后至少 1 个月时疼痛或功能障碍的关系。两名审查员独立评估研究的合格性、完成数据提取和进行质量评估。当一个预后因素在两个或更多研究中报告时，进行了荟萃分析。
从电子数据库搜索中确定了 10992 项研究，其中 18 项被纳入，研究了 62 个潜在的预后因素。在临床环境中，由于数据不足，无法进行荟萃分析。一些单研究报告了与疼痛和/或残疾的正相关，年龄较大、基线疼痛强度和基线功能障碍在多个随访时间和结局组合中存在。在社区环境中，两项研究的荟萃分析发现，中期（1 年）随访时持续性疼痛存在的预后因素为年龄较大（OR 1.25；95%CI=1.05-1.47）、每周白天疲倦（OR 1.69；95%CI=1.14-2.51）、每周腹痛（OR 1.44；95%CI=1.03-2.02）和夜间醒来（OR 1.49；95%CI=1.05-2.13）。社区环境中没有研究报告功能障碍的预后因素。
确定了与未来疼痛和残疾有显著关联的预后因素；然而，由于很少有研究在一个以上可比的研究中进行调查，因此结果需要谨慎解释。
来自生物心理社会各个方面的预后因素在儿科疼痛临床实践中很重要。然而，到目前为止，大多数专家之前已经达成一致的预后因素尚未在前瞻性队列研究中进行评估。这些发现可能有助于在疼痛和功能障碍结局的背景下，在对出现疼痛的儿童进行临床评估时，确定优先收集的数据。
