Department of Anesthesiology and Perioperative Medicine, Department of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University, Kingston, Canada.
Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada.
Anesthesiology. 2024 Mar 1;140(3):442-449. doi: 10.1097/ALN.0000000000004850.
Given the widespread recognition that postsurgical movement-evoked pain is generally more intense, and more functionally relevant, than pain at rest, the authors conducted an update to a previous 2011 review to re-evaluate the assessment of pain at rest and movement-evoked pain in more recent postsurgical analgesic clinical trials.
The authors searched MEDLINE and Embase for postsurgical pain randomized controlled trials and meta-analyses published between 2014 and 2023 in the setting of thoracotomy, knee arthroplasty, and hysterectomy using methods consistent with the original 2011 review. Included trials and meta-analyses were characterized according to whether they acknowledged the distinction between pain at rest and movement-evoked pain and whether they included pain at rest and/or movement-evoked pain as a pain outcome. For trials measuring movement-evoked pain, pain-evoking maneuvers used to assess movement-evoked pain were tabulated.
Among the 944 included trials, 504 (53%) did not measure movement-evoked pain (vs. 61% in 2011), and 428 (45%) did not distinguish between pain at rest and movement-evoked pain when defining the pain outcome (vs. 52% in 2011). Among the 439 trials that measured movement-evoked pain, selection of pain-evoking maneuver was highly variable and, notably, was not even described in 139 (32%) trials (vs. 38% in 2011). Among the 186 included meta-analyses, 94 (51%) did not distinguish between pain at rest and movement-evoked pain (vs. 71% in 2011).
This updated review demonstrates a persistent limited proportion of trials including movement-evoked pain as a pain outcome, a substantial proportion of trials failing to distinguish between pain at rest and movement-evoked pain, and a lack of consistency in the use of pain-evoking maneuvers for movement-evoked pain assessment. Future postsurgical trials need to (1) use common terminology surrounding pain at rest and movement-evoked pain, (2) assess movement-evoked pain in virtually every trial if not contraindicated, and (3) standardize movement-evoked pain assessment with common, procedure-specific pain-evoking maneuvers. More widespread knowledge translation and mobilization are required in order to disseminate this message to current and future investigators.
鉴于人们普遍认识到术后运动诱发的疼痛通常比静息时的疼痛更剧烈，且与功能更相关，因此作者对 2011 年的一篇综述进行了更新，以重新评估最近的术后镇痛临床试验中静息痛和运动诱发痛的评估方法。
作者使用与原始 2011 年综述一致的方法，在胸腔切开术、膝关节置换术和子宫切除术的背景下，检索了 2014 年至 2023 年间发表的术后疼痛随机对照试验和荟萃分析的 MEDLINE 和 Embase。根据是否承认静息痛和运动诱发痛之间的区别，以及是否将静息痛和/或运动诱发痛作为疼痛结局纳入研究，对纳入的试验和荟萃分析进行了特征描述。对于测量运动诱发痛的试验，列出了用于评估运动诱发痛的疼痛诱发操作。
在纳入的 944 项试验中，504 项（53%）未测量运动诱发痛（2011 年为 61%），428 项（45%）在定义疼痛结局时未区分静息痛和运动诱发痛（2011 年为 52%）。在测量运动诱发痛的 439 项试验中，疼痛诱发操作的选择差异很大，值得注意的是，139 项（32%）试验甚至没有描述（2011 年为 38%）。在纳入的 186 项荟萃分析中，94 项（51%）未区分静息痛和运动诱发痛（2011 年为 71%）。
本更新综述表明，作为疼痛结局纳入运动诱发痛的试验比例仍然有限，相当一部分试验未能区分静息痛和运动诱发痛，用于运动诱发痛评估的疼痛诱发操作缺乏一致性。未来的术后试验需要：（1）使用围绕静息痛和运动诱发痛的通用术语，（2）如果不是禁忌，几乎在每个试验中评估运动诱发痛，（3）使用通用的、特定于手术程序的疼痛诱发操作来标准化运动诱发痛评估。为了向当前和未来的研究人员传播这一信息，需要更广泛的知识转化和动员。
