Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Scand J Pain. 2023 Jun 19;23(3):501-510. doi: 10.1515/sjpain-2023-0016. Print 2023 Jul 26.
The objective of this longitudinal cohort study was to investigate if preoperative pain mechanisms, anxiety, and depression increase risk of developing chronic post-thoracotomy pain (CPTP) after lung cancer surgery.
Patients with suspected or confirmed lung cancer undergoing surgery by either video-assisted thoracoscopic surgery or anterior thoracotomy were recruited consecutively. Preoperative assessments were conducted by: quantitative sensory testing (QST) (brush, pinprick, cuff pressure pain detection threshold, cuff pressure tolerance pain threshold, temporal summation and conditioned pain modulation), neuropathic pain symptom inventory (NPSI), and the Hospital Anxiety and Depression Scale (HADS). Clinical parameters in relation to surgery were also collected. Presence of CPTP was determined after six months and defined as pain of any intensity in relation to the operation area on a numeric rating scale form 0 (no pain) to 10 (worst pain imaginable).
A total of 121 patients (60.2 %) completed follow-up and 56 patients (46.3 %) reported CPTP. Development of CPTP was associated with higher preoperative HADS score (p=0.025), higher preoperative NPSI score (p=0.009) and acute postoperative pain (p=0.042). No differences were observed in relation to preoperative QST assessment by cuff algometry and HADS anxiety and depression sub-scores.
High preoperative HADS score preoperative pain, acute postoperative pain intensity, and preoperative neuropathic symptoms were was associated with CPTP after lung cancer surgery. No differences in values of preoperative QST assessments were found. Preoperative assessment and identification of patients at higher risk of postoperative pain will offer opportunity for further exploration and development of preventive measures and individualised pain management depending on patient risk profile.
本纵向队列研究的目的是探讨肺癌手术后慢性手术后胸痛（CPTP）发生的风险是否与术前疼痛机制、焦虑和抑郁有关。
连续招募接受电视辅助胸腔镜手术或前开胸手术的疑似或确诊肺癌患者。术前评估包括：定量感觉测试（QST）（毛刷、刺痛、袖带压力疼痛检测阈值、袖带压力耐受疼痛阈值、时间总和和条件疼痛调制）、神经病理性疼痛症状量表（NPSI）和医院焦虑抑郁量表（HADS）。还收集了与手术相关的临床参数。术后 6 个月确定 CPTP 的存在，并定义为在数字评分量表上与手术区域相关的任何强度的疼痛，范围为 0（无痛）至 10（可想象到的最严重疼痛）。
共有 121 例患者（60.2%）完成了随访，56 例患者（46.3%）报告了 CPTP。CPTP 的发展与较高的术前 HADS 评分（p=0.025）、较高的术前 NPSI 评分（p=0.009）和急性术后疼痛（p=0.042）相关。袖带压痛法的术前 QST 评估和 HADS 焦虑和抑郁子评分与 CPTP 无差异。
术前 HADS 评分高、术前疼痛、急性术后疼痛强度和术前神经病理性症状与肺癌手术后 CPTP 相关。术前 QST 评估值无差异。术前评估和识别术后疼痛风险较高的患者将为进一步探索和制定预防措施以及根据患者风险状况进行个体化疼痛管理提供机会。
