Liu Yiyun, Xia Guangmei, Mo Mianmian, Tu Shumin, Meng Xueqing, Chen Cui, Zhou Fang
School of Nursing, Xuzhou Medical University, Xuzhou City, Jiangsu Province, China.
Department of Cardiothoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, China.
Eur J Pain. 2026 Feb;30(2):e70218. doi: 10.1002/ejp.70218.
This study aimed to investigate the types of pain trajectories after video-assisted thoracoscopic surgery in patients with pulmonary nodules, and to explore the influencing factors of different pain trajectories, to provide potential intervention targets and practical basis for clinical precision pain management.
202 patients with pulmonary nodules who underwent thoracoscopic surgery were selected as the study subjects. The baseline data of patients was collected using the general data questionnaire, Pain Sensitivity Questionnaire, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Brief Fatigue Inventory, and Pain Catastrophic Scale. Numerical rating scale was used to assess patients' pain level at 7 time points from 1 to 3 days, 1 week, month 1, 3, and 6. The growth mixture model (GMM) was applied to identify pain trajectory categories, and multinomial logistic regression analysis was conducted to investigate the influencing factors of post-thoracoscopic pain trajectories.
Three types of pain trajectories were identified: moderate pain rapid decline group (68.3%), moderate pain initial increase followed by rapid decline group (23.9%), and severe pain slow decline group (7.7%). Multinomial logistic regression results show that history of chronic pain, pain sensitivity, postoperative PCIA dosage, acute postoperative pain, and preoperative fatigue are independent predictors of the unfavourable pain trajectory after thoracoscopic surgery (p < 0.05).
There is population heterogeneity in post-thoracoscopic pain in patients with pulmonary nodules and it may be closely related to a variety of preoperative and postoperative somatic sensations. Based on this, medical staff need to develop targeted interventions for patients to improve their postoperative pain.
This study identifies the group heterogeneity of pain trajectories after video-assisted thoracoscopic surgery in patients with pulmonary nodules and provides longitudinal follow-up data at more time points and over a longer time span. Also, we analyse in detail their possible influencing factors of pain trajectories from a variety of perspectives to provide potential intervention targets and practice basis for precise clinical pain management, which can positively contribute to the improvement of patients' postoperative quality of life.
本研究旨在调查肺结节患者电视辅助胸腔镜手术后的疼痛轨迹类型，探讨不同疼痛轨迹的影响因素，为临床精准疼痛管理提供潜在干预靶点及实践依据。
选取202例行胸腔镜手术的肺结节患者作为研究对象。采用一般资料问卷、疼痛敏感性问卷、医院焦虑抑郁量表、匹兹堡睡眠质量指数、简明疲劳量表及疼痛灾难化量表收集患者的基线资料。采用数字评分量表在术后1至3天、1周、1个月、3个月和6个月这7个时间点评估患者的疼痛程度。应用生长混合模型（GMM）识别疼痛轨迹类别，并进行多项逻辑回归分析以探讨胸腔镜术后疼痛轨迹的影响因素。
识别出三种疼痛轨迹类型：中度疼痛快速下降组（68.3%）、中度疼痛先升高后快速下降组（23.9%）和重度疼痛缓慢下降组（7.7%）。多项逻辑回归结果显示，慢性疼痛史、疼痛敏感性、术后自控静脉镇痛（PCIA）用量、术后急性疼痛及术前疲劳是胸腔镜手术后不良疼痛轨迹的独立预测因素（p < 0.05）。
肺结节患者胸腔镜术后存在人群异质性，且可能与多种术前和术后躯体感觉密切相关。基于此，医护人员需要为患者制定针对性干预措施以改善其术后疼痛。
本研究识别了肺结节患者电视辅助胸腔镜手术后疼痛轨迹的组间异质性，并提供了更多时间点和更长时间跨度的纵向随访数据。此外，我们从多个角度详细分析了疼痛轨迹可能的影响因素，为临床精准疼痛管理提供潜在干预靶点及实践依据，这能够对改善患者术后生活质量产生积极作用。
