Suppr超能文献

识别疼痛表型:术后慢性疼痛转变中变异性的生物心理社会学来源。

Recognizing pain phenotypes: biopsychosocial sources of variability in the transition to chronic postsurgical pain.

作者信息

Schreiber Kristin L, Wilson Jenna M, Chen Yun-Yun Kathy

机构信息

Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/ Harvard Medical School, Boston, Massachusetts, USA

Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/ Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Reg Anesth Pain Med. 2025 Feb 5;50(2):86-92. doi: 10.1136/rapm-2024-105602.

Abstract

Chronic postsurgical pain (CPSP) is a cause of new chronic pain, with a wide range of reported incidence. Previous longitudinal studies suggest that development of CPSP may depend more on the constellation of risk factors around a patient (pre-existing pain phenotype) rather than on the extent of surgical injury itself. The biopsychosocial model of pain outlines a broad array of factors that modulate the severity, longevity, and impact of pain. Biological variables associated with CPSP include age, sex, baseline pain sensitivity, and opioid tolerance. Psychological factors, including anxiety, depression, somatization, sleep disturbance, catastrophizing, and resilience, and social factors, like education and social support, may also importantly modulate CPSP. Prevention efforts have targeted acute pain reduction using multimodal analgesia (regional anesthesia and intraoperative analgesic adjuvant medications). However, studies that do not measure or take phenotypic risk factors into account (either using them for enrichment or statistically as effect modifiers) likely suffer from underpowering, and thus, fail to discern subgroups of patients that preventive measures may be most helpful to. Early preoperative identification of a patient's pain phenotype allows estimation of their constellation of risk factors and may greatly enhance successful, personalized prevention of postoperative pain. Effective preoperative employment of behavioral interventions like cognitive-behavioral therapy, stress reduction, and physical and mental prehabilitation may particularly require knowledge of a patient's pain phenotype. Preoperative assessment of patients' pain phenotypes will not only inform high-quality personalized perioperative care clinically, but it will enable enriched testing of novel therapies in future scientific studies.

摘要

慢性术后疼痛(CPSP)是一种新的慢性疼痛病因,其报道的发病率范围很广。先前的纵向研究表明,CPSP的发生可能更多地取决于患者周围的危险因素组合(预先存在的疼痛表型),而不是手术损伤本身的程度。疼痛的生物心理社会模型概述了一系列调节疼痛严重程度、持续时间和影响的因素。与CPSP相关的生物学变量包括年龄、性别、基线疼痛敏感性和阿片类药物耐受性。心理因素,包括焦虑、抑郁、躯体化、睡眠障碍、灾难化和心理弹性,以及社会因素,如教育和社会支持,也可能对CPSP产生重要调节作用。预防措施旨在通过多模式镇痛(区域麻醉和术中镇痛辅助药物)减轻急性疼痛。然而,那些没有测量或考虑表型危险因素(要么将其用于富集分析,要么在统计学上作为效应修饰因素)的研究可能存在效能不足的问题,因此无法识别出预防措施可能最有帮助的患者亚组。术前早期识别患者的疼痛表型可以估计其危险因素组合,并可能极大地提高术后疼痛的成功个性化预防。有效术前应用认知行为疗法、减压以及身心预康复等行为干预措施可能特别需要了解患者的疼痛表型。术前评估患者的疼痛表型不仅将在临床上为高质量的个性化围手术期护理提供依据,而且将使未来科学研究中对新疗法的富集测试成为可能。

相似文献

2
Identifying risk factors for chronic postsurgical pain and preventive measures: a comprehensive update.
Expert Rev Neurother. 2023 Jul-Dec;23(12):1297-1310. doi: 10.1080/14737175.2023.2284872. Epub 2023 Dec 15.
3
Prognostic factors of chronic postsurgical pain in children and adolescents: a systematic review and meta-analysis.
Reg Anesth Pain Med. 2025 Feb 5;50(2):144-152. doi: 10.1136/rapm-2024-105696.
6
Risk factors for persistent postoperative opioid use: an entity distinct from chronic postsurgical pain.
Reg Anesth Pain Med. 2025 Feb 5;50(2):121-128. doi: 10.1136/rapm-2024-105599.
8
Prevention of Chronic Postsurgical Pain: The Effect of Preventive and Multimodal Analgesia.
Asian J Anesthesiol. 2018 Sep;56(3):74-82. doi: 10.6859/aja.201809_56(3).0002.
9
[Chronic postsurgical pain].
Ann Fr Anesth Reanim. 2013 Jun;32(6):422-35. doi: 10.1016/j.annfar.2013.04.012. Epub 2013 Jun 7.
10
The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis.
Anesth Analg. 2012 Aug;115(2):428-42. doi: 10.1213/ANE.0b013e318249d36e. Epub 2012 Mar 13.

引用本文的文献

1
Insights and progress on postoperative analgesia of radical gastrectomy for gastric cancer: a comprehensive review.
Front Pain Res (Lausanne). 2025 Jun 30;6:1601220. doi: 10.3389/fpain.2025.1601220. eCollection 2025.

本文引用的文献

1
Preoperative pain sensitivity and its correlation with postoperative acute and chronic pain: a systematic review and meta-analysis.
Br J Anaesth. 2024 Sep;133(3):591-604. doi: 10.1016/j.bja.2024.05.010. Epub 2024 Jun 15.
2
The Impact of Nutrition on Pain: A Narrative Review of Recent Literature.
Curr Pain Headache Rep. 2024 Oct;28(10):1059-1066. doi: 10.1007/s11916-024-01275-x. Epub 2024 Jun 14.
6
A systematic review with meta-analyses of the association between stigma and chronic pain outcomes.
Pain. 2024 Aug 1;165(8):1689-1701. doi: 10.1097/j.pain.0000000000003243. Epub 2024 May 16.
7
Trajectories of pain and opioid use up to one year after surgery: analysis of a European registry.
Br J Anaesth. 2024 Mar;132(3):588-598. doi: 10.1016/j.bja.2023.12.002. Epub 2024 Jan 10.
8
Association of Genetic Variants with Postsurgical Pain: A Systematic Review and Meta-analyses.
Anesthesiology. 2023 Dec 1;139(6):827-839. doi: 10.1097/ALN.0000000000004677.
9
Prognostic models for chronic postsurgical pain-Current developments, trends, and challenges.
Curr Opin Anaesthesiol. 2023 Oct 1;36(5):580-588. doi: 10.1097/ACO.0000000000001299. Epub 2023 Jul 27.
10
Uncoupling Pain and Opioid Use after Surgery.
Anesthesiology. 2023 May 1;138(5):457-459. doi: 10.1097/ALN.0000000000004552.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验