Tan Hon Sen, Sultana Rehena, Han Nian-Lin Reena, Tan Chin Wen, Sia Alex Tiong Heng, Sng Ban Leong
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
J Pain Res. 2020 Aug 24;13:2151-2162. doi: 10.2147/JPR.S255336. eCollection 2020.
Hysterectomy is associated with a high incidence of chronic post-hysterectomy pain (CPHP). Pain catastrophizing, a negative cognitive-affective response to pain, is associated with various pain disorders but its role in CPHP is unclear. We aimed to determine the association of high preoperative pain catastrophizing with CPHP development and functional impairment 4 months after surgery.
Secondary analysis of a prospective cohort study of women undergoing abdominal/laparoscopic hysterectomy to investigate the association between high pain catastrophizing (pain catastrophizing scale, PCS≥20) with CPHP and associated functional impairment (defined as impairment with standing for ≥30 minutes, sitting for ≥30 minutes, or walking up or down stairs). CPHP and functional impairment were assessed via 4- and 6-month phone surveys.
Of 216 patients, 72 (33.3%) had high PCS, with mean (SD) of 30.0 (7.9). In contrast, 144 (66.7%) patients had low PCS, with mean (SD) of 9.0 (4.7). At 4 months, 26/63 (41.3%) patients in the high PCS group developed CPHP, compared to 24/109 (22.0%) in the low PCS group. At 6 months, 14/53 (26.4%) high PCS patients developed CPHP, compared to 10/97 (10.3%) patients with low PCS. High PCS was independently associated with CPHP at 4 months (OR 2.49 [95% CI 1.27 to 4.89], p=0.0082) and 6 months (OR 3.12 [95% CI 1.28 to 7.64], p=0.0126) but was not associated with functional impairment. High PCS≥20, presence of evoked mechanical temporal summation (MTS), and history of abdominal/pelvic surgery predict CPHP at 4 months with area under the curve (AUC) of 0.69. Similarly, PCS≥20 and increasing MTS magnitude predicted CPHP at 6 months with AUC of 0.76.
High PCS was independently associated with CPHP. Future studies should identify other CPHP associated factors to formulate a risk-prediction model and investigate the effectiveness of early intervention for pain catastrophizers in improving pain-related outcomes.
子宫切除术与慢性子宫切除术后疼痛（CPHP）的高发病率相关。疼痛灾难化是对疼痛的一种消极认知-情感反应，与多种疼痛障碍有关，但其在CPHP中的作用尚不清楚。我们旨在确定术前高疼痛灾难化与术后4个月CPHP发生及功能障碍之间的关联。
对接受腹部/腹腔镜子宫切除术的女性进行的一项前瞻性队列研究的二次分析，以调查高疼痛灾难化（疼痛灾难化量表，PCS≥20）与CPHP及相关功能障碍（定义为站立≥30分钟、坐着≥30分钟或上下楼梯有障碍）之间的关联。通过4个月和6个月的电话调查评估CPHP和功能障碍。
在216例患者中，72例（33.3%）PCS较高，平均（标准差）为30.0（7.9）。相比之下，144例（66.7%）患者PCS较低，平均（标准差）为9.0（4.7）。在4个月时，高PCS组63例患者中有26例（41.3%）发生CPHP，而低PCS组109例患者中有24例（22.0%）发生。在6个月时，高PCS患者中有14例（26.4%）发生CPHP，而低PCS患者中有10例（10.3%）发生。高PCS在4个月时（OR 2.49 [95% CI 1.27至4.89]，p = 0.0082）和6个月时（OR 3.12 [95% CI 1.28至7.64]，p = 0.0126）与CPHP独立相关，但与功能障碍无关。高PCS≥20、诱发机械性时间总和（MTS）的存在以及腹部/盆腔手术史可预测4个月时的CPHP，曲线下面积（AUC）为0.69。同样，PCS≥20和MTS幅度增加可预测6个月时的CPHP，AUC为0.76。
高PCS与CPHP独立相关。未来的研究应确定其他与CPHP相关的因素，以制定风险预测模型，并研究对疼痛灾难化者进行早期干预在改善疼痛相关结局方面的有效性。
