Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Department of Counseling, Higher Education and Special Education University of Maryland, College Park, MD, USA.
J Psychosom Res. 2021 May;144:110418. doi: 10.1016/j.jpsychores.2021.110418. Epub 2021 Mar 17.
Acute respiratory distress syndrome (ARDS) survivors frequently experience bodily pain during recovery after the intensive care unit. Longitudinal course, risk factors and associations with physical and neuropsychological health is lacking.
We collected self-reported pain using the Short Form-36 Bodily Pain (SF-36 BP) scale, normalized for sex and age (range: 0-100; higher score = less pain), along with physical and mental health measures in a multi-center, prospective cohort of 826 ARDS survivors at 6- and 12-month follow-up. We examined baseline and ICU variables' associations with pain via separate unadjusted regression models.
Pain prevalence (SF-36 BP ≤40) was 45% and 42% at 6 and 12 months, respectively. Among 706 patients with both 6- and 12-month data, 34% reported pain at both timepoints. Pre-ARDS employment was associated with less pain at 6-months (mean difference (standard error), 5.7 (0.9), p < 0.001) and 12-months (6.3 (0.9), p < 0.001); smoking history was associated with greater pain (-5.0 (0.9), p < 0.001, and - 5.4 (1.0), p < 0.001, respectively). In-ICU opioid use was associated with greater pain (-6.3 (2.7), p = 0.02, and - 7.3 (2.8), p = 0.01, respectively). At 6 months, 174 (22%) patients reported co-occurring pain, depression and anxiety, and 227 (33%) reported co-occurring pain and impaired physical function.
Nearly half of ARDS survivors reported bodily pain at 6- and 12-month follow-up; one-third reported pain at both time points. Pre-ARDS unemployment, smoking history, and in-ICU opioid use may identify patients who report greater pain during recovery. Given its frequent co-occurrence, clinicians should manage both physical and neuropsychological issues when pain is reported.
急性呼吸窘迫综合征（ARDS）幸存者在重症监护病房后康复期间经常经历身体疼痛。缺乏对纵向病程、风险因素以及与身体和神经心理健康的关联的研究。
我们使用简化 36 项健康调查躯体疼痛（SF-36 BP）量表，对多中心前瞻性 ARDS 幸存者队列中的 826 名幸存者进行了 6 个月和 12 个月随访，该量表通过性别和年龄进行了标准化（范围：0-100；分数越高表示疼痛越少），并同时测量了身体和心理健康指标。我们通过单独的未调整回归模型，研究了基线和 ICU 变量与疼痛的关联。
疼痛发生率（SF-36 BP≤40）分别为 6 个月时的 45%和 12 个月时的 42%。在 706 名同时具有 6 个月和 12 个月数据的患者中，34%的患者在两个时间点均报告有疼痛。ARDS 前就业与 6 个月时疼痛程度较轻相关（平均差值（标准误差），5.7（0.9），p<0.001）和 12 个月时疼痛程度较轻相关（6.3（0.9），p<0.001）；吸烟史与疼痛程度增加相关（分别为-5.0（0.9），p<0.001 和-5.4（1.0），p<0.001）。ICU 内使用阿片类药物与疼痛程度增加相关（分别为-6.3（2.7），p=0.02 和-7.3（2.8），p=0.01）。在 6 个月时，174 名（22%）患者报告同时存在疼痛、抑郁和焦虑，227 名（33%）患者报告同时存在疼痛和身体功能受损。
近一半的 ARDS 幸存者在 6 个月和 12 个月随访时报告存在躯体疼痛；三分之一的患者在两个时间点均报告疼痛。ARDS 前失业、吸烟史和 ICU 内使用阿片类药物可能会识别出在康复期间报告疼痛程度较大的患者。鉴于疼痛常同时存在，当报告疼痛时，临床医生应同时管理身体和神经心理问题。
