Ramo Sama, Frangakis Stephan, Waljee Jennifer F, Bicket Mark C
Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA.
Reg Anesth Pain Med. 2025 Feb 5;50(2):121-128. doi: 10.1136/rapm-2024-105599.
Despite a decline in opioid prescriptions over the past decade, patients commonly receive opioid analgesics as a treatment for postoperative pain in the USA. One complication that patients may experience after surgery is persistent postoperative opioid use (PPOU), or opioid use beyond the typical recovery period. Often defined as beyond 3 months postsurgery, PPOU is frequently conflated with chronic postsurgical pain (CPSP), where pain persists well after the expected healing time following surgery. This narrative review explores the distinct risk factors for each condition, their interrelation, and potential future research directions.For PPOU, major risk factors include the risky use of substances including misuse and use disorders; depression and other mental health disorders; a history of chronic pain before surgery including back pain; and certain surgical types (ie, total knee arthropathy, open cholecystectomy, total hip arthropathy). Conversely, CPSP risk factors include the type of surgery (ie, thoracic and breast surgeries), mental health conditions (particularly catastrophizing), and pain in both the preoperative and postoperative phases. Despite the overlap of some factors, studies typically employ different frameworks when examining PPOU and CPSP, with a biopsychosocial model applied for CPSP and little emphasis on an individual's social environment employed for PPOU. Additionally, existing studies predominantly rely on retrospective insurance claims data, which may not capture the full scope of risk factors.To fill gaps in understanding, investigations may prospectively assess and analyze patient-reported outcomes, implement similar frameworks, and concurrently measure both conditions to advance the scientific understanding of PPOU and CPSP.
尽管在过去十年中阿片类药物的处方量有所下降，但在美国，患者通常会接受阿片类镇痛药来治疗术后疼痛。患者术后可能经历的一种并发症是持续性术后阿片类药物使用（PPOU），即超出典型恢复期的阿片类药物使用。PPOU通常被定义为术后3个月以上，它经常与慢性术后疼痛（CPSP）相混淆，CPSP是指在手术后预期愈合时间很久之后疼痛仍持续存在。本叙述性综述探讨了每种情况的不同风险因素、它们之间的相互关系以及未来潜在的研究方向。对于PPOU，主要风险因素包括物质的危险使用，包括滥用和使用障碍；抑郁和其他心理健康障碍；手术前的慢性疼痛史，包括背痛；以及某些手术类型（即全膝关节置换术、开腹胆囊切除术、全髋关节置换术）。相反，CPSP的风险因素包括手术类型（即胸科和乳腺手术）、心理健康状况（特别是灾难化思维）以及术前和术后阶段的疼痛。尽管有些因素存在重叠，但研究在检查PPOU和CPSP时通常采用不同的框架，CPSP采用生物心理社会模型，而PPOU很少强调个体的社会环境。此外，现有研究主要依赖回顾性保险理赔数据，这可能无法涵盖所有风险因素。为了填补认识上的空白，研究可以前瞻性地评估和分析患者报告的结果，采用类似的框架，并同时测量这两种情况，以推进对PPOU和CPSP的科学认识。
