Schreiber Kristin L, Wilson Jenna M, Chen Yun-Yun Kathy
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.
Reg Anesth Pain Med. 2025 Feb 5;50(2):86-92. doi: 10.1136/rapm-2024-105602.
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.
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。
