Campos Hércules Lázaro Moraes, Liebano Richard Eloin, Lima Camila Astolphi, Perracini Monica Rodrigues
Universidade Cidade de São Paulo, São Paulo, Brazil.
Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil.
Br J Pain. 2020 Feb;14(1):5-13. doi: 10.1177/2049463719861994. Epub 2019 Jul 3.
Older adults experience significant chronic pain after hip fracture, resulting in decreased physical functioning. However, pain investigation in this population is mostly limited to self-reported pain intensity. Detailed pain assessment may identify intervention targets other than pain relief. The aim of this study is to investigate multiple dimensions of pain experience (intensity, sensory, affective, evaluative and miscellaneous dimensions) and to correlate them to lower limb functionality and limitations in daily living activities.
We conducted a cross-sectional study of 50 older adults (77.1 ± 8.1 years old) who underwent hip fracture surgery in the past 4 months. We used the Numeric Rating Scale (NRS), the McGill Pain Questionnaire (MPQ) and an algometer to assess pain intensity, pain quality and pressure pain threshold, respectively. Lower limb functionality and limitation in basic (activities of daily living (ADL)) and instrumental activities of daily living (IADL) were assessed using the Short Physical Performance Battery (SPPB) and the Brazilian OARS Multidimensional Functional Assessment Questionnaire.
Participants described pain as brief, momentary and transient, especially during weight-bearing activities. Although the pain intensity measured by the NRS was reported as moderate to severe (7.5 ± 1.6 points), it was not correlated with physical functioning. However, we observed a moderate negative correlation between pressure pain threshold, ADL and IADL disability ( = -0.41, < 0.01). Among pain qualities, the sensory category was moderately negatively correlated to SPPB ( = -0.41, < 0.01), and the evaluative category was moderately correlated to ADL and IADL disability ( = 0.43, < 0.01).
Pain can be present 4 months after hip fracture surgery, particularly during weight-bearing activities, and it is associated with poor lower limb functionality, as well as ADL and IADL disability. Older adults may benefit from pain assessments that go beyond pain intensity measurements after hip fracture, as this helps clinicians optimise pain management and overall functional recovery.
老年人髋部骨折后会经历严重的慢性疼痛，导致身体功能下降。然而，对这一人群的疼痛调查大多局限于自我报告的疼痛强度。详细的疼痛评估可能会确定除缓解疼痛之外的干预目标。本研究的目的是调查疼痛体验的多个维度（强度、感觉、情感、评价和其他维度），并将它们与下肢功能以及日常生活活动中的限制相关联。
我们对50名在过去4个月内接受髋部骨折手术的老年人（77.1±8.1岁）进行了一项横断面研究。我们分别使用数字评分量表（NRS）、麦吉尔疼痛问卷（MPQ）和痛觉计来评估疼痛强度、疼痛性质和压痛阈值。使用简短体能测试电池（SPPB）和巴西OARS多维功能评估问卷评估下肢功能以及基本日常生活活动（ADL）和工具性日常生活活动（IADL）中的限制。
参与者将疼痛描述为短暂的、瞬间的和一过性的，尤其是在负重活动期间。尽管NRS测量的疼痛强度报告为中度至重度（7.5±1.6分），但它与身体功能无关。然而，我们观察到压痛阈值、ADL和IADL残疾之间存在中度负相关（r = -0.41，P < 0.01）。在疼痛性质中，感觉类别与SPPB中度负相关（r = -0.41，P < 0.01），评价类别与ADL和IADL残疾中度相关（r = 0.43，P < 0.01）。
髋部骨折手术后4个月仍可能存在疼痛，尤其是在负重活动期间，并且它与下肢功能差以及ADL和IADL残疾有关。老年人可能会从髋部骨折后超越疼痛强度测量的疼痛评估中受益，因为这有助于临床医生优化疼痛管理和整体功能恢复。
