Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA.
Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA; Washington University Pain Center, Washington University School of Medicine in St Louis, St Louis, MO, USA.
Br J Anaesth. 2020 May;124(5):614-622. doi: 10.1016/j.bja.2020.02.002. Epub 2020 Mar 10.
Impaired performance on tasks assessing executive function has been linked to chronic pain. We hypothesised that poor performance on tests assessing the ability to adjust thinking in response to changing environmental stimuli (cognitive flexibility) would be associated with persistent post-surgical pain.
We conducted a single-centre prospective observational study in two perioperative cohorts: patients undergoing total knee arthroplasty or noncardiac chest surgical procedures. The co-primary outcome measures compared preoperative performance on the Trail Making Test and the colour-word matching Stroop test between patients who developed persistent post-surgical pain and those who did not. Secondary outcome measures included the associations between these test scores and pain severity at 6 months.
Of 300 participants enrolled, 198 provided 6 month follow-up data. There were no significant differences in preoperative Trail Making Test B minus A times (33 vs 34 s; P=0.59) or Stroop interference T-scores (47th vs 48th percentile; P=0.50) between patients with and without persistent post-surgical pain (primary outcome). Of those who reported persistent post-surgical pain, poorer baseline performance on the colour-word matching Stroop test was associated with higher pain scores at 6 months in both knee arthroplasty (r=-0.32; P=0.04) and chest (r=-0.44; P=0.02) surgeries (secondary outcome).
Preoperative cognitive flexibility test performance was not predictive of overall persistent post-surgical pain incidence 6 months after surgery. However, poor performance on the colour-word matching Stroop test was independently associated with more severe persistent post-surgical pain in both cohorts.
NCT02579538.
执行功能任务表现受损与慢性疼痛有关。我们假设，在评估根据环境变化调整思维能力（认知灵活性）的测试中表现不佳与术后持续性疼痛有关。
我们在两个围手术期队列中进行了一项单中心前瞻性观察研究：接受全膝关节置换术或非心脏胸部手术的患者。主要结局指标比较了发生持续性术后疼痛和未发生持续性术后疼痛患者的术前 Trail Making 测试和颜色-词语匹配 Stroop 测试的表现。次要结局指标包括这些测试分数与术后 6 个月时疼痛严重程度的关系。
在纳入的 300 名参与者中，有 198 名提供了 6 个月的随访数据。在持续性术后疼痛患者和无持续性术后疼痛患者之间，术前 Trail Making 测试 B 减去 A 时间（33 秒与 34 秒；P=0.59）或 Stroop 干扰 T 评分（第 47 百分位与第 48 百分位；P=0.50）无显著差异（主要结局）。在报告持续性术后疼痛的患者中，膝关节置换术（r=-0.32；P=0.04）和胸部手术（r=-0.44；P=0.02）中，基线时颜色-词语匹配 Stroop 测试表现较差与术后 6 个月时的疼痛评分较高相关（次要结局）。
术前认知灵活性测试表现不能预测术后 6 个月时总体持续性术后疼痛的发生率。然而，在两个队列中，颜色-词语匹配 Stroop 测试表现不佳与更严重的持续性术后疼痛独立相关。
NCT02579538。
