Cohen Steven P, Wang Eric J, Roybal Alexandra, Chen Yian
Anesthesiology, Neurology, Physical Medicine and Rehabilitation, Psychiatry, Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Physical Medicine and Rehabilitation, and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
BMJ Med. 2025 Jul 7;4(1):e001143. doi: 10.1136/bmjmed-2024-001143. eCollection 2025.
Chronic pain is the leading cause of years lost to disability worldwide, by a large margin, affecting 20-34% of the world's population. Chronic pain is the target for an increasing number of invasive and expensive treatments, supported by different levels of evidence. At a time when personalised medicine, driven in part by the growth of artificial intelligence, is surging, a scoping review on the factors that affect pain outcomes for procedural interventions is needed. A scoping review is important because placebo controlled trials for the most commonly used treatments consistently show small-to-moderate effect sizes of <0.5 that are often overshadowed by the placebo effect. In this article, personal characteristics, and social and clinical factors that influence surgical and non-surgical procedure pain and functional outcomes are reviewed, their intersectionality is briefly explored, and the evidence base for how dealing with these factors can influence outcomes is outlined.
慢性疼痛是全球因残疾而损失的年数的主要原因，远远超过其他原因，影响着全球20%至34%的人口。慢性疼痛正成为越来越多侵入性且昂贵治疗的目标，这些治疗有不同程度的证据支持。在部分由人工智能发展推动的精准医学蓬勃发展之际，有必要对影响程序性干预疼痛结果的因素进行一项范围综述。范围综述很重要，因为针对最常用治疗方法的安慰剂对照试验一直显示效应量小至中等，小于0.5，且往往被安慰剂效应所掩盖。在本文中，我们回顾了影响手术和非手术程序疼痛及功能结果的个人特征、社会和临床因素，简要探讨了它们的交叉性，并概述了应对这些因素如何影响结果的证据基础。
