Anesthesiology. 2021 Jun 1;134(6):915-924. doi: 10.1097/ALN.0000000000003754.
Pain that lingers beyond the early weeks after the acute postoperative period is an important risk factor for chronic postsurgical pain. This study examined the hypothesis that patients' expectations about their postsurgical pain would be independently associated with lingering postsurgical pain.
The study included 3,628 patients who underwent diverse surgeries between February 2015 and October 2016 in a single U.S. tertiary hospital and participated in the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) observational study. Preoperatively, patients were asked about their expectations about pain 1 month after surgery. Patients were considered to have lingering postsurgical pain if they endorsed having pain in the area related to their surgeries during a follow-up survey obtained 1 to 3 months postoperatively. The independent associations between preselected perioperative variables and lingering postsurgical pain were evaluated.
Of the cohort, 36% (1,308 of 3,628) experienced lingering postsurgical pain. Overall, two thirds (2,414 of 3,628) expected their postsurgical pain to be absent or improved from baseline, and 73% of these had their positive expectations fulfilled. A total of 19% (686 of 3,628) expected new, unabated, or worsened pain, and only 39% (257 of 661) of these had their negative expectations fulfilled. Negative expectations were most common in patients with presurgical pain unrelated to the reason for surgery, undergoing surgeries not typically performed to help alleviate pain. Endorsing negative expectations was independently associated with lingering postsurgical pain (odds ratio, 1.56; 95% CI, 1.23 to 1.98; P < 0.001). Additional major factors associated with lingering postsurgical pain included recollection of severe acute postoperative pain (odds ratio, 3.13; 95% CI, 2.58 to 3.78; P < 0.001), undergoing a procedure typically performed to help alleviate pain (odds ratio, 2.18; 95% CI, 1.73 to 2.75; P < 0.001), and preoperative pain related to surgery (odds ratio, 1.91; 95% CI, 1.52 to 2.40; P < 0.001).
Lingering postsurgical pain is relatively common after diverse surgeries and is associated with both fixed surgical characteristics and potentially modifiable factors like pain expectations and severe acute postoperative pain.
急性术后早期过后仍持续存在的疼痛是慢性术后疼痛的一个重要危险因素。本研究检验了如下假设，即患者对术后疼痛的预期将与持续存在的术后疼痛独立相关。
该研究纳入了 2015 年 2 月至 2016 年 10 月期间在美国一家三级医院接受各种手术且参加了系统评估和术后 1 年随访结果靶向改善服务（SATISFY-SOS）观察性研究的 3628 例患者。术前，患者被问及他们对术后 1 个月疼痛的预期。如果患者在术后 1 至 3 个月的随访调查中报告手术相关区域存在疼痛，则认为其存在持续存在的术后疼痛。评估了术前选定的围手术期变量与持续存在的术后疼痛之间的独立关联。
在该队列中，36%（3628 例中的 1308 例）经历了持续存在的术后疼痛。总体而言，三分之二（3628 例中的 2414 例）预期术后疼痛会从基线水平减轻或消失，其中 73%的患者的预期得到了满足。有 19%（3628 例中的 686 例）预期会出现新的、持续的或加重的疼痛，而这些患者中只有 39%（686 例中的 257 例）的预期得到了满足。在术前与手术原因无关的疼痛、接受通常不能缓解疼痛的手术的患者中，负面预期最为常见。对负面预期的认可与持续存在的术后疼痛独立相关（比值比，1.56；95%置信区间，1.23 至 1.98；P<0.001）。与持续存在的术后疼痛相关的其他主要因素包括回忆起严重的急性术后疼痛（比值比，3.13；95%置信区间，2.58 至 3.78；P<0.001）、接受通常用于缓解疼痛的手术（比值比，2.18；95%置信区间，1.73 至 2.75；P<0.001）和与手术相关的术前疼痛（比值比，1.91；95%置信区间，1.52 至 2.40；P<0.001）。
多种手术后持续存在的术后疼痛较为常见，与固定的手术特征以及潜在可改变的因素（如疼痛预期和严重的急性术后疼痛）均相关。
