Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland.
Institute of Medical Statistics, Computer and Data Sciences, University Hospital Jena, Jena, Germany.
Pain. 2022 Dec 1;163(12):2457-2465. doi: 10.1097/j.pain.0000000000002653. Epub 2022 Apr 19.
Chronic postsurgical pain (CPSP) is defined by pain intensity and pain-related functional interference. This study included measures of function in a composite score of patient-reported outcomes (PROs) to investigate the incidence of CPSP. Registry data were analyzed for PROs 1 day and 12 months postoperatively. Based on pain intensity and pain-related interference with function, patients were allocated to the groups " CPSPF " (at least moderate pain with interference), " mixed " (milder symptoms), and " no CPSPF ". The incidence of CPSPF was compared with CPSP rates referring to published data. Variables associated with the PRO-12 score (composite PROs at 12 months; numeric rating scale 0-10) were analyzed by linear regression analysis. Of 2319 patients, 8.6%, 32.5%, and 58.9% were allocated to the groups CPSPF , mixed , and no CPSPF , respectively. Exclusion of patients whose pain scores did not increase compared with the preoperative status, resulted in a 3.3% incidence. Of the patients without pre-existing pain, 4.1% had CPSPF. Previously published pain cutoffs of numeric rating scale >0, ≥3, or ≥4, used to define CPSP, produced rates of 37.5%, 9.7%, and 5.7%. Pre-existing chronic pain, preoperative opioid medication, and type of surgery were associated with the PRO-12 score (all P < 0.05). Opioid doses and PROs 24 hours postoperatively improved the fit of the regression model. A more comprehensive assessment of pain and interference resulted in lower CPSP rates than previously reported. Although inclusion of CPSP in the ICD-11 is a welcome step, evaluation of pain characteristics would be helpful in differentiation between CPSPF and continuation of pre-existing chronic pain.
慢性术后疼痛（CPSP）定义为疼痛强度和与疼痛相关的功能障碍。本研究包括患者报告结果（PROs）的综合评分中的功能测量，以调查 CPSP 的发生率。对术后 1 天和 12 个月的 PRO 进行了登记数据分析。根据疼痛强度和与功能相关的干扰，将患者分配到“CPSPF”（至少有中度疼痛伴干扰）、“混合”（症状较轻）和“无 CPSPF”组。将 CPSPF 的发生率与参考已发表数据的 CPSP 发生率进行比较。通过线性回归分析对与 PRO-12 评分相关的变量（12 个月时的综合 PRO；数字评定量表 0-10）进行分析。在 2319 例患者中，分别有 8.6%、32.5%和 58.9%的患者被分配到 CPSPF、混合和无 CPSPF 组。排除与术前相比疼痛评分没有增加的患者后，发生率为 3.3%。在无术前疼痛的患者中，有 4.1%的患者有 CPSPF。先前发表的使用数字评定量表>0、≥3 或≥4 来定义 CPSP 的疼痛截止值，其发生率分别为 37.5%、9.7%和 5.7%。术前慢性疼痛、术前阿片类药物和手术类型与 PRO-12 评分相关（均 P <0.05）。阿片类药物剂量和术后 24 小时 PROs 改善了回归模型的拟合度。更全面的疼痛和干扰评估导致 CPSP 发生率低于先前报告的发生率。虽然将 CPSP 纳入 ICD-11 是一个受欢迎的步骤，但评估疼痛特征将有助于区分 CPSPF 和持续存在的术前慢性疼痛。
