Emergency, Hopital du Sacre-Coeur de Montreal Centre de Recherche, Montreal, Quebec, Canada
Faculte de medecine, Université de Montréal, Montréal, Quebec, Canada.
BMJ Open. 2020 Dec 7;10(12):e040390. doi: 10.1136/bmjopen-2020-040390.
Inadequate acute pain management can reduce the quality of life, cause unnecessary suffering and can often lead to the development of chronic pain. Using group-based trajectory modelling, we previously identified six distinct pain intensity trajectories for the first 14-day postemergency department (ED) discharge; two linear ones with moderate or severe pain during follow-up (~40% of the patients) and four cubic polynomial order trajectories with mild or no pain at the end of the 14 days (low final pain trajectories). We assessed if previously described acute pain intensity trajectories over 14 days after ED discharge are predictive of chronic pain 3 months later.
Prospective cohort study.
Tertiary care trauma centre academic hospital.
This study included 18 years and older ED patients who consulted for acute (≤2 weeks) pain conditions that were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity (0-10 numeric rating scale).
Three months after ED visit, participants were questioned by phone about their current pain intensity (0-10 numeric rating scale). Chronic pain was defined as patients with current pain intensity ≥4 at 3 months.
A total of 305 participants remained in the study at 3 months, 49% were women and a mean age of 55±15 years. Twelve per cent (11.9; 95% CI 8.2 to 15.4) of patients had chronic pain at the 3-month follow-up. Controlling for age, sex and pain condition, patients with moderate or severe pain trajectories and those with only a severe pain trajectory were respectively 5.1 (95% CI 2.2 to 11.8) and 8.2 (95% CI 3.4 to 20.0) times more likely to develop chronic pain 3 months later compared with patients in the low final pain trajectories.
Specific acute pain trajectories following an ED visit are closely related to the development of chronic pain 3 months later.
NCT02799004; Results.
急性疼痛管理不足会降低生活质量，导致不必要的痛苦，并且常常会导致慢性疼痛的发展。我们先前使用基于群组的轨迹建模方法，确定了急诊科（ED）出院后前 14 天内的六种不同的疼痛强度轨迹；两种线性轨迹在随访期间存在中度或重度疼痛（~40%的患者），以及四种四次多项式顺序轨迹在 14 天结束时疼痛轻微或无疼痛（低最终疼痛轨迹）。我们评估了 ED 出院后 14 天内先前描述的急性疼痛强度轨迹是否可预测 3 个月后的慢性疼痛。
前瞻性队列研究。
三级护理创伤中心学术医院。
这项研究纳入了 18 岁及以上的 ED 患者，他们因急性（≤2 周）疼痛就诊，并开了阿片类药物处方出院。患者完成了 14 天的日记，其中列出了他们的每日疼痛强度（0-10 数字评分量表）。
ED 就诊后 3 个月，通过电话询问患者当前的疼痛强度（0-10 数字评分量表）。慢性疼痛定义为患者在 3 个月时的当前疼痛强度≥4。
共有 305 名患者在 3 个月时仍留在研究中，其中 49%为女性，平均年龄为 55±15 岁。12%（11.9；95%CI 8.2 至 15.4）的患者在 3 个月随访时患有慢性疼痛。控制年龄、性别和疼痛状况后，中重度疼痛轨迹的患者和仅有重度疼痛轨迹的患者分别有 5.1（95%CI 2.2 至 11.8）和 8.2（95%CI 3.4 至 20.0）倍更有可能在 3 个月后发展为慢性疼痛。
ED 就诊后特定的急性疼痛轨迹与 3 个月后慢性疼痛的发展密切相关。
NCT02799004；结果。
