Padhy Shibani, Fatima Ruhi, Jena Shubhranshu, Kar Akhya Kumar, Durga Padmaja, Neeradi Vishal Kumar
Department of Anaesthesiology and Critical Care, Hyderabad, Telangana, India.
Department of Anaesthesiology and Critical Care, ESI Medical College and Hospital, Hyderabad, Telangana, India.
J Anaesthesiol Clin Pharmacol. 2023 Oct-Dec;39(4):603-608. doi: 10.4103/joacp.joacp_187_22. Epub 2023 Dec 12.
The importance of non-noxious contextual inputs in the interplay of pain with neurophysiologic and behavioral factors is gaining recognition. Stress of impending surgery can act as a negative context, leading to a decrease in pain threshold in patients. This study was conducted to assess the influence of stress conferred by the imminent and other contextual inputs such as anxiety, socioeconomic status, prior painful experience, and the effect of gender on modulation of pain perception in patients undergoing elective surgery.
In total, 120 patients aged between 18 and 60 years of either gender posted for elective gastrointestinal surgery under general anesthesia were recruited. Data were collected on preoperative anxiety level, socioeconomic status, education, and any prior painful experience. A pressure algometer was used to measure the pressure pain thresholds and pain tolerance on the day before surgery and on the morning of surgery in the preoperative suite.
There was a statistically significant decrease in both pain threshold ( < 0.0001) and pain tolerance in the immediate preoperative period in comparison to the baseline readings taken the day before surgery ( = 0.048). The magnitude of change in pain scalars was greater in females ( < 0.001), those with a high anxiety score, and a history of severe painful experience in the past.
Preoperative surgical stress lowers the pain threshold and pain tolerance. Contextual modulation of pain by factors such as anxiety and memory of prior painful experience, especially in the female gender, could influence postoperative patient outcomes and warrants further research.
无害性情境输入在疼痛与神经生理及行为因素相互作用中的重要性正日益得到认可。即将进行手术的压力可作为一种负面情境，导致患者疼痛阈值降低。本研究旨在评估即将进行手术所带来的压力以及焦虑、社会经济地位、既往疼痛经历等其他情境输入的影响，以及性别对择期手术患者疼痛感知调节的作用。
总共招募了120名年龄在18至60岁之间、接受全身麻醉下择期胃肠手术的患者，无论性别。收集了术前焦虑水平、社会经济地位、教育程度以及任何既往疼痛经历的数据。在手术前一天以及术前病房手术当天上午，使用压力痛觉计测量压力疼痛阈值和疼痛耐受性。
与手术前一天所测的基线读数相比，术前即刻疼痛阈值（<0.0001）和疼痛耐受性均有统计学意义的降低（=0.048）。疼痛量表变化幅度在女性（<0.001）、焦虑评分高以及过去有严重疼痛经历的患者中更大。
术前手术压力会降低疼痛阈值和疼痛耐受性。焦虑和既往疼痛经历记忆等因素对疼痛的情境调节，尤其是在女性中，可能会影响术后患者的预后，值得进一步研究。
