Defense and Veterans Center for Integrative Pain Management, Department of Military and Emergency Medicine, Uniformed Services University, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
Defense and Veterans Center for Integrative Pain Management, Department of Military and Emergency Medicine, Uniformed Services University, Rockville, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
Arch Phys Med Rehabil. 2020 Oct;101(10):1754-1762. doi: 10.1016/j.apmr.2020.04.023. Epub 2020 May 21.
To investigate pain catastrophizing presentations up to 6 months postoperatively and subsequent changes in pain intensity and physical function.
Prospective observational multisite study.
Two tertiary care facilities between 2016 and 2019.
Adult patients (N=348) undergoing a mastectomy, thoracic surgery, total knee or hip arthroplasty, spinal fusion, or major abdominal surgery.
Not applicable.
Pain Catastrophizing Scale scores, Defense and Veterans Pain Rating Scale, average pain intensity, and Patient Reported Outcomes Measurement Information System (PROMIS) physical function.
Four pain catastrophizing trajectories were identified in 348 surgical patients during the 6 months of postoperative recovery: stable, remitting, worsening, and unremitting. Linear mixed-effects models found that the unremitting trajectory was associated with higher pain intensity over time. The average pain intensity of participants in the remitting trajectory was estimated to decrease at a faster rate over the 6 months after surgery than pain of other trajectories, despite participants reporting high preoperative Pain Catastrophizing Scale and pain scores. Worsening and unremitting trajectories were associated with reduced physical function. Preoperative average pain intensity scores were not associated with postoperative physical function scores, nor were participants' preoperative physical function scores associated with average pain intensity scores postoperatively. Prolonged hospitalization, smoking, and preoperative opioid prescriptions were associated with the unremitting trajectory.
Findings suggest that preoperative pain catastrophizing scores alone may not be adequate for estimating long-term patient-reported outcomes during postoperative rehabilitation. Pain catastrophizing has a dynamic presentation and is associated with changes in pain intensity and physical function up to 6 months postoperatively. Routine assessments can inform the delivery of early interventions to surgical patients at risk of experiencing a pain catastrophizing trajectory associated with suboptimal outcomes during rehabilitation.
调查术后 6 个月内的疼痛灾难化表现，以及随后疼痛强度和身体功能的变化。
前瞻性观察性多中心研究。
2016 年至 2019 年期间的两家三级保健机构。
接受乳房切除术、胸外科手术、全膝关节或髋关节置换术、脊柱融合术或大腹部手术的成年患者（N=348）。
不适用。
疼痛灾难化量表评分、防御和退伍军人疼痛评分量表、平均疼痛强度以及患者报告的结果测量信息系统（PROMIS）身体功能。
在 348 例手术患者的术后康复 6 个月期间，确定了 4 种疼痛灾难化轨迹：稳定型、缓解型、恶化型和持续型。线性混合效应模型发现，持续型与随时间推移疼痛强度增加相关。尽管参与者报告术前疼痛灾难化量表和疼痛评分较高，但缓解型轨迹的参与者平均疼痛强度估计在术后 6 个月内以更快的速度下降。恶化型和持续型轨迹与身体功能下降相关。术前平均疼痛强度评分与术后身体功能评分无关，参与者术前身体功能评分也与术后平均疼痛强度评分无关。长时间住院、吸烟和术前阿片类药物处方与持续型轨迹相关。
研究结果表明，术前疼痛灾难化评分可能不足以估计术后康复期间的长期患者报告结局。疼痛灾难化具有动态表现，并与术后 6 个月内疼痛强度和身体功能的变化相关。常规评估可以为处于康复期间出现疼痛灾难化轨迹风险的手术患者提供早期干预措施，以获得不理想结局的风险。
