胰腺管阻塞、异常疼痛处理和心理困扰对慢性胰腺炎患者报告结局的重叠和累积影响。

Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis.

机构信息

Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark

Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

出版信息

Gut. 2022 Dec;71(12):2518-2525. doi: 10.1136/gutjnl-2021-325855. Epub 2021 Oct 21.

DOI:10.1136/gutjnl-2021-325855

PMID:34675068

Abstract

OBJECTIVE

Several factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs).

DESIGN

We performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses.

RESULTS

Clinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p<0.001) and pain interference scores (p<0.001), and a reduction in quality of life (p<0.001). All factors had independent and direct effects on PROs, with the strongest effect size observed for psychological distress.

CONCLUSION

Pain-related factors in chronic pancreatitis are often present in an overlapping manner and have a cumulative detrimental effect on PROs. These findings support a multidisciplinary strategy for pain management.

TRIAL REGISTRATION NUMBER

The study was registered with ClinicalTrials.gov (NCT03434392).

摘要

目的

有几种因素被认为与慢性胰腺炎患者的疼痛有关。然而，目前尚不清楚这些因素是否存在重叠，以及它们是否对患者报告的结局（PROs）有累积影响。

设计

我们对 201 名明确诊断为慢性胰腺炎的前瞻性患者进行了一项多中心横断面研究。所有患者均接受了胰管阻塞评估、使用定量感觉测试评估疼痛处理异常以及基于有效问卷进行心理困扰（焦虑、抑郁和疼痛灾难化）筛查。异常由正常参考值定义。PROs 包括疼痛症状严重程度（简明疼痛量表）和生活质量（EORTC-QLQ-C30 问卷）。通过线性趋势分析、多元回归模型和中介分析来研究与疼痛相关的因素与 PROs 之间的关系。

结果

临床评估提示胰管阻塞的发生率为 29%，疼痛处理异常为 23%，焦虑为 47%，抑郁为 39%，疼痛灾难化为 28%；这些因素中的每一种都与至少一种 PRO 的严重程度相关。有两种或两种以上因素的患者占 51%。随着因素数量的增加，疼痛严重程度评分（p<0.001）和疼痛干扰评分（p<0.001）增加，生活质量降低（p<0.001）。所有因素对 PROs 均有独立且直接的影响，心理困扰的效应量最大。