Department of Orthopaedics, Duke University, Durham, North Carolina.
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Pain Med. 2023 Mar 1;24(3):258-268. doi: 10.1093/pm/pnac150.
High-impact chronic pain (HICP) is a term that characterizes the presence of a severe and troubling pain-related condition. To date, the prevalence of HICP in lumbar spine surgery recipients and their HICP transitions from before to after surgery are unexplored. The purpose was to define HICP prevalence, transition types, and outcomes in lumbar spine surgery recipients and to identify predictors of HICP outcomes.
In total, 43,536 lumbar surgery recipients were evaluated for HICP transition. Lumbar spine surgery recipients were categorized as having HICP preoperatively and at 3 months after surgery if they exhibited chronic and severe pain and at least one major activity limitation. Four HICP transition groups (Stable Low Pain, Transition from HICP, Transition to HICP, and Stable High Pain) were categorized and evaluated for outcomes. Multivariate multinomial modeling was used to predict HICP transition categorization.
In this sample, 15.1% of individuals exhibited HICP preoperatively; this value declined to 5.1% at 3 months after surgery. Those with HICP at baseline and 3 months had more comorbidities and worse overall outcomes. Biological, psychological, and social factors predicted HICP transition or Stable High Pain; some of the strongest involved social factors of 2 or more to transition to HICP (OR = 1.43; 95% CI = 1.21-1.68), and baseline report of pain/disability (OR = 3.84; 95% CI = 3.20-4.61) and psychological comorbidity (OR = 1.78; 95% CI = 1.48-2.12) to Stable Stable High Pain.
The percentage of individuals with HICP preoperatively (15.1%) was low, which further diminished over a 3-month period (5.1%). Postoperative HICP groups had higher levels of comorbidities and worse baseline outcomes scores. Transition to and maintenance of HICP status was predicted by biological, psychological, and social factors.
高度影响性慢性疼痛（HICP）是一个术语，用于描述严重和困扰性疼痛相关疾病的存在。迄今为止，腰椎手术接受者中 HICP 的患病率及其手术前后 HICP 的转变尚不清楚。目的是定义腰椎手术接受者中 HICP 的患病率、转变类型和结果，并确定 HICP 结果的预测因素。
共评估了 43536 例腰椎手术接受者的 HICP 转变情况。如果腰椎手术接受者在术前和术后 3 个月表现出慢性和严重疼痛，以及至少一项主要活动受限，则被归类为术前和术后存在 HICP。将 HICP 转变分为 4 个组（稳定低疼痛、从 HICP 转变、向 HICP 转变和稳定高疼痛）进行评估和结果比较。采用多变量多项式模型预测 HICP 转变分类。
在该样本中，术前有 15.1%的人患有 HICP；术后 3 个月这一比例下降至 5.1%。基线和术后 3 个月有 HICP 的患者合并症更多，总体结局更差。生物、心理和社会因素预测了 HICP 的转变或稳定高疼痛；其中一些最强的因素涉及到 2 个或更多的社会因素，导致向 HICP 转变（OR=1.43；95%CI=1.21-1.68），以及基线报告的疼痛/残疾（OR=3.84；95%CI=3.20-4.61）和心理合并症（OR=1.78；95%CI=1.48-2.12）与稳定高疼痛有关。
术前患有 HICP 的个体比例（15.1%）较低，术后 3 个月进一步降低（5.1%）。术后 HICP 组合并症水平更高，基线结局评分更差。生物、心理和社会因素预测了向 HICP 的转变和 HICP 状态的维持。
