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术前疼痛水平可预测退行性椎间盘疾病手术患者的慢性疼痛——一项前瞻性研究

The Preoperative Level of Pain Predicts Chronic Pain in Patients Operated on for Degenerative Disc Disease-A Prospective Study.

作者信息

Pawełczyk Agnieszka, Jekimov Rusłan, Lusa Weronika, Jabbar Redwan, Kruzerowska Katarzyna, Pawełczyk Tomasz, Radek Maciej

机构信息

Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland.

Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland.

出版信息

J Clin Med. 2025 May 15;14(10):3467. doi: 10.3390/jcm14103467.

Abstract

Postoperative pain is an unpleasant experience for the patient and impairs postoperative functional outcomes. The current literature on the influence of preoperative predictors on postoperative pain outcomes remains limited. This study aimed to identify sociodemographic, clinical, psychological, and temperamental predictors of postoperative pain in patients undergoing surgery for degenerative disc disease (DDD). : Eighty-one adults with DDD, qualified for neurosurgical intervention, were enrolled. All patients underwent neurological and psychiatric evaluations, as well as preoperative pain assessments using the Visual Analogue Scale (VAS) and the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychological assessments included the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Somatic Symptom Scale, temperament, and personality inventories (e.g., FCB-TI, NEO-FFI), and cognitive tests (Trail Making Test, Digit Span Test). Postoperative pain was re-evaluated with the VAS 12 weeks after surgery. Data were analyzed using univariate and multivariate statistical methods. : Univariate analyses revealed significant differences between the defined groups regarding lack of improvement of pain 12 weeks after surgery compared to preoperative VAS, systolic blood pressure, and four scales from the WHYMPI. However, stepwise logistic regression identified only preoperative VAS score as an independent predictor of postoperative pain improvement. Receiver Operating Characteristic analysis and Youden's index indicated a preoperative VAS cut-off score of 6 as the most predictive. : A VAS score of 6 or more before surgery independently predicts the absence of chronic pain 12 weeks postoperatively for patients without neurological deficits. Moreover, given the complexity of this topic, further prospective, randomized controlled research is essential.

摘要

术后疼痛对患者来说是一种不愉快的体验,并且会损害术后功能结局。目前关于术前预测因素对术后疼痛结局影响的文献仍然有限。本研究旨在确定退行性椎间盘疾病(DDD)手术患者术后疼痛的社会人口统计学、临床、心理和气质方面的预测因素。:81名符合神经外科干预条件的DDD成年患者被纳入研究。所有患者均接受了神经和精神评估,以及使用视觉模拟量表(VAS)和西黑文-耶鲁多维疼痛量表(WHYMPI)进行的术前疼痛评估。心理评估包括感知压力量表、医院焦虑抑郁量表、躯体症状量表、气质和人格量表(如FCB-TI、NEO-FFI)以及认知测试(连线测验、数字广度测验)。术后12周用VAS对术后疼痛进行重新评估。采用单变量和多变量统计方法分析数据。:单变量分析显示,与术前VAS、收缩压以及WHYMPI的四个量表相比,在术后12周疼痛改善情况方面,所定义的组之间存在显著差异。然而,逐步逻辑回归仅确定术前VAS评分是术后疼痛改善的独立预测因素。受试者工作特征分析和尤登指数表明,术前VAS临界值为6时预测性最强。:术前VAS评分为6或更高可独立预测无神经功能缺损患者术后12周无慢性疼痛。此外,鉴于该主题的复杂性,进一步的前瞻性、随机对照研究至关重要。

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