Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Pain. 2020 Nov-Dec;21(11-12):1125-1137. doi: 10.1016/j.jpain.2020.01.004. Epub 2020 Jan 30.
Abdominal and peritoneal pain after surgery is common and burdensome, yet the lack of standardized diagnostic criteria for this type of acute pain impedes basic, translational, and clinical investigations. The collaborative effort among the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, American Pain Society, and American Academy of Pain Medicine Pain Taxonomy (AAAPT) provides a systematic framework to classify acute painful conditions. Using this framework, a multidisciplinary working group reviewed the literature and developed core diagnostic criteria for acute abdominal and peritoneal pain after surgery. In this report, we apply the proposed AAAPT framework to 4 prototypical surgical procedures resulting in abdominal and peritoneal pain as examples: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection. These diagnostic criteria address the 3 most common surgical procedures performed in the United States, capture diverse surgical approaches, and may also be applied to other surgical procedures resulting in abdominal and peritoneal pain. Additional investigation regarding the validity and reliability of this framework will facilitate its adoption in research that advances our comprehension of mechanisms, deliver better treatments, and help prevent the transition of acute to chronic pain after surgery in the abdominal and peritoneal region. PERSPECTIVE: Using AAAPT, we present key diagnostic criteria for acute abdominal and peritoneal pain after surgery. We provide a systematic classification using 5 dimensions for abdominal and peritoneal pain that occurs after surgery, in addition to 4 specific surgical procedures: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection.
手术后的腹部和腹膜疼痛很常见且令人痛苦，但缺乏针对这种急性疼痛的标准化诊断标准，妨碍了基础、转化和临床研究。镇痛、麻醉和成瘾临床试验转化、创新、机会和网络、美国疼痛协会和美国疼痛医学疼痛分类学（AAAPT）之间的合作努力提供了一个系统框架，用于对急性疼痛状况进行分类。使用这个框架，一个多学科工作组审查了文献，并为手术后急性腹部和腹膜疼痛制定了核心诊断标准。在本报告中，我们将提出的 AAAPT 框架应用于 4 种导致腹部和腹膜疼痛的典型手术示例：剖腹产、胆囊切除术、结直肠手术和胰腺切除术。这些诊断标准涵盖了美国最常见的 3 种手术，捕捉到了不同的手术方法，也可能适用于其他导致腹部和腹膜疼痛的手术。进一步研究该框架的有效性和可靠性将有助于在研究中采用该框架，从而增进我们对机制的理解，提供更好的治疗方法，并有助于预防手术后腹部和腹膜区域急性疼痛向慢性疼痛的转变。观点：使用 AAAPT，我们提出了手术后急性腹部和腹膜疼痛的关键诊断标准。我们提供了一个系统的分类，使用 5 个维度来描述手术后发生的腹部和腹膜疼痛，以及 4 种特定的手术：剖腹产、胆囊切除术、结直肠手术和胰腺切除术。
