Sydora Beate C, Whelan Lindsay Jane, Abelseth Benjamin, Brar Gurpreet, Idris Sumera, Zhao Rachel, Leonard Ashley Jane, Rosenbloom Brittany N, Clarke Hance, Katz Joel, Beesoon Sanjay, Rasic Nivez
Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
J Pain Res. 2024 Jul 30;17:2511-2530. doi: 10.2147/JPR.S466731. eCollection 2024.
Risk factors for the development of chronic postsurgical pain (CPSP) have been reported in primary studies and an increasing number of reviews. The objective of this umbrella review was to compile and understand the published presurgical risk factors associated with the development of CPSP for various surgery types.
Six databases were searched from January 2000 to June 2023 to identify meta-analyses, scoping studies, and systematic reviews investigating presurgical CPSP predictors in adult patients. Articles were screened by title/abstract and subsequently by full text by two independent reviewers. The selected papers were appraised for their scientific quality and validity. Data were extracted and descriptively analyzed.
Of the 2344 retrieved articles, 36 reviews were selected for in-depth scrutiny. The number of primary studies in these reviews ranged from 4 to 317. The surgery types assessed were arthroplasty (n = 13), spine surgery (n = 8), breast surgery (n = 4), shoulder surgery (n = 2), thoracic surgery (n = 2), and carpal tunnel syndrome (n = 1). One review included a range of orthopedic surgeries; six reviews included a variety of surgeries. A total of 39 presurgical risk factors were identified, some of which shared the same defining tool. Risk factors were themed into six broad categories: psychological, pain-related, health-related, social/lifestyle-related, demographic, and genetic. The strength of evidence for risk factors was inconsistent across different reviews and, in some cases, conflicting. A consistently high level of evidence was found for preoperative pain, depression, anxiety, and pain catastrophizing.
This umbrella review identified a large number of presurgical risk factors which have been suggested to be associated with the development of CPSP after various surgeries. The identification of presurgical risk factors is crucial for the development of screening tools to predict CPSP. Our findings will aid in designing screening tools to better identify patients at risk of developing CPSP and inform strategies for prevention and treatment.
在初步研究及越来越多的综述中，已报道了慢性术后疼痛（CPSP）发生的风险因素。本综合性综述的目的是汇总并了解已发表的与各种手术类型的CPSP发生相关的术前风险因素。
检索了2000年1月至2023年6月的六个数据库，以识别调查成年患者术前CPSP预测因素的荟萃分析、范围界定研究和系统评价。文章先通过标题/摘要进行筛选，随后由两名独立评审员进行全文筛选。对所选论文的科学质量和有效性进行评估。提取数据并进行描述性分析。
在检索到的2344篇文章中，选择了36篇综述进行深入审查。这些综述中的初步研究数量从4项到317项不等。评估的手术类型包括关节成形术（n = 13）、脊柱手术（n = 8）、乳腺手术（n = 4）、肩部手术（n = 2）、胸外科手术（n = 2）和腕管综合征手术（n = 1）。一项综述涵盖了一系列骨科手术；六项综述涵盖了多种手术。共确定了39个术前风险因素，其中一些使用相同的定义工具。风险因素分为六大类：心理、疼痛相关、健康相关、社会/生活方式相关、人口统计学和遗传。不同综述中风险因素的证据强度不一致，在某些情况下相互矛盾。术前疼痛、抑郁、焦虑和疼痛灾难化方面始终存在高水平的证据。
本综合性综述确定了大量术前风险因素，这些因素被认为与各种手术后CPSP的发生有关。术前风险因素的识别对于开发预测CPSP的筛查工具至关重要。我们的研究结果将有助于设计筛查工具，以更好地识别有发生CPSP风险的患者，并为预防和治疗策略提供信息。
