Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Plast Surg Hand Surg. 2020 Oct;54(5):317-322. doi: 10.1080/2000656X.2020.1780246. Epub 2020 Jun 26.
Chronic pain after breast surgery including breast reconstruction is a major concern for patients. However, the factors associated with chronic pain after breast surgery are uncertain in Japanese population. The aim of this study was to identify patient-specific and medical/surgical factors that predict chronic pain after breast surgery in Japanese patients. The subjects were 189 Japanese women undergoing breast surgery including tissue expander/implant (TE/implant), deep inferior epigastric perforator (DIEP) procedures and mastectomy only. Pain was assessed at one year postoperatively using a validated survey instrument: the Japanese version of the Short-Form McGill Pain Questionnaire (SF-MPQ-JV). A multiple linear regression model was used to examine the relationships of clinical factors with postoperative pain. Surveys were completed by 141 subjects. A younger age ( = .04) and bilateral procedures ( < .05) were both closely associated with the extent of increased postoperative pain at 1 year using the MPQ-Total pain rating. Compared to total mastectomy only, TE/implant procedures showed a significantly lower visual analog scale (VAS) ( = .04) and present pain index (PPI) ( = .03) scores. No factor related to chronic pain was also significantly related to the frequency of pain medication use postoperatively or the effect of social life of the patients. This study identified patients at risk for greater chronic pain after breast surgery. These findings will allow surgeons to improve patient comfort, reduce clinical morbidity and enhance patient satisfaction with their surgical outcome. : BMI: body mass index; CI: confidence interval; DIEP: deep inferior epigastric perforator flap; MPQ: McGill pain questionnaire; PPI: present pain index; SD: standard deviation; SF-MPQ-JV: Japanese version of the short-form McGill pain questionnaire; TE: tissue expander; VAS: visual analog scale.
乳房手术后的慢性疼痛（包括乳房重建）是患者关注的主要问题。然而，在日本人群中，与乳房手术后慢性疼痛相关的因素尚不确定。本研究的目的是确定与日本患者乳房手术后慢性疼痛相关的患者特异性和医疗/手术因素。研究对象为 189 名接受乳房手术（包括组织扩张器/植入物[TE/implant]、腹壁下动脉穿支皮瓣[DIEP]和单纯乳房切除术）的日本女性。使用经过验证的调查工具：日本版简短形式 McGill 疼痛问卷（SF-MPQ-JV）在术后一年评估疼痛。使用多元线性回归模型检查临床因素与术后疼痛的关系。完成了 141 项调查。年龄较小（ = .04）和双侧手术（ < .05）与术后 1 年 MPQ 总疼痛评分的疼痛程度增加密切相关。与单纯全乳房切除术相比，TE/implant 手术的视觉模拟量表（VAS）（ = .04）和现有疼痛指数（PPI）（ = .03）评分明显较低。与慢性疼痛相关的任何因素也与术后疼痛药物使用频率或患者社会生活的影响均无显著相关性。本研究确定了乳房手术后慢性疼痛风险较高的患者。这些发现将使外科医生能够提高患者舒适度，降低临床发病率并提高患者对手术结果的满意度。 : BMI: 体重指数; CI: 置信区间; DIEP: 腹壁下动脉穿支皮瓣; MPQ: McGill 疼痛问卷; PPI: 现有疼痛指数; SD: 标准差; SF-MPQ-JV: 日本版简短形式 McGill 疼痛问卷; TE: 组织扩张器; VAS: 视觉模拟量表。
