术后慢性疼痛流行病学及风险因素的研究进展

背景 外科手术后出现的术后急性疼痛(acute post-surgical pain,APSP)大多随着创伤的愈合而消失,但部分患者会转变为术后慢性疼痛(chronic post-surgical pain,CPSP).文献报道CPSP流行病学差异较大,目前尚没有明确、有效的预防和治疗方法. 目的 加强对CPSP的认识,建立有效的预防体系,提高治疗效果及改善患者预后. 内容 简述CPSP流行病学、风险因素、预防措施和临床治疗. 趋向 随着对CPSP研究的深入,CPSP的预防和治疗会得到进一步优化,最终造福患者.     

急性术后疼痛危险因素和疼痛程度预测方法的研究进展

急性术后疼痛(APP)是患者受到手术刺激后出现的一系列生理、心理及行为反应等,主要集中在术后24～72 h,常持续4～6 d.APP严重影响手术预后,而导致患者APP治疗不充分的原因较多,因此,APP的管理重点在于对疼痛的评估和预防,充分理解和掌握APP危险因素和疼痛程度预测方法对于APP的管理十分必要.APP的危险因...     

产后慢性泌尿生殖疼痛的危险因素分析

目的 探讨产后慢性泌尿生殖疼痛(chronic urogenital pain,CUP)相关性盆底肌损伤的主要危险因素.方法 选取2018年5月至2020年4月产后42 d至6个月于我院盆底康复中心行产后随访并诊断为CUP的患者120例为研究对象(CUP组),以同期来我院行产后随访无盆底功能障碍性疾病的妇女100例为对...     

Modifiable risk factors for chronic back pain: insights using the co-twin control design

Background

Inconsistent associations between modifiable risk factors and chronic back pain (CBP) may be due to the inability of traditional epidemiologic study designs to properly account for an array of potential genetic and environmental confounding factors. The co-twin control research design, comparing modifiable risk factors in twins discordant for CBP, offers a unique way to remove numerous confounding factors.

肛肠手术后慢性疼痛的危险因素分析

目的 探讨肛肠手术后慢性疼痛（CPSP）的危险因素。
方法 收集2018年8月至2019年10月择期行肛肠手术746例患者资料,并记录人口学特征、合并症、术前疼痛情况、围术期情况等。通过电话随访术后1、3个月时的疼痛情况,根据术后是否发生CPSP将患者分为两组：CPSP组和非CPSP组。采用多因素Logistic回归分析CPSP的危险因素。
结果 有37例（4.96％）患者发生CPSP。与非CPSP组比较,CPSP组术前合并疼痛、高血压、贫血、术后7 d VAS疼痛评分>3分、术后发生出血、睡眠障碍和便秘的比例明显升高（P<0.05）。多因素Logistic回归分析显示,术前疼痛（OR=3.022,P=0.013）、术前贫血（OR=2.235,P=0.017）、术后出血（OR=3.511,P=0.034）、术后睡眠障碍（OR=2.345,P=0.003）以及术后7 d VAS疼痛评分>3分（OR=4.323,P=0.006）是发生肛肠手术后CPSP的危险因素。
结论 肛肠手术CPSP发生率较低,术前疼痛、术前贫血、术后出血、术后睡眠障碍以及术后7 d VAS疼痛评分>3分是发生肛肠手术CPSP的危险因素。     

Management of postthoracotomy pain: acute and chronic

Given the discomfort of thoracic surgical incisions, thoracic surgeons must understand and use contemporary multimodality pain treatments. Acute postthoracotomy pain not only causes psychologic distress to the patient but also has detrimental effects on pulmonary function and postoperative mobility, leading to increased morbidity. By choosing the most appropriate and least traumatic surgical incision, adhering to meticulous surgical techniques, and avoiding intercostal nerve injury or rib fractures, surgeons can minimize postoperative pain. Aggressive perioperative and postoperative pain management is best accomplished with use of an epidural anesthetic and covering breakthrough pain with an IV-PCA. Alternatively, an infusion system for continuous administration of local anesthetics directly in the subpleural plane, posterior to the intercostal incision, also provides excellent pain control. Again, use of an IV-PCA as adjuvant therapy is recommended. With careful planning, severe pain and its negative impact on thoracic surgical patients can be prevented.     

冠状动脉旁路移植术后慢性疼痛发生率及其相关因素

目的 了解冠状动脉旁路移植术(CABG)后患者开胸术后慢性疼痛综合征(PTPS)的发生率,对其可能影响因素进行相关分析.方法 选取本院CABG后62例患者,复习病历以了解患者基本情况、术前疼痛情况、麻醉情况、手术情况及术后情况;根据简明疼痛问卷和语言评价量表(VRS)评分对患者慢性手术后疼痛情况进行电话回访.结果 最终完成调查患者共计54例,PTPS的发病率为53.70%,其中胸骨切口愈合部位针刺样疼痛5例、烧灼样疼痛8例及胀痛17例,伴有局部皮肤疼痛敏感12例.疼痛症状持续和/或间断出现1年14例,2年9例,3年6例.PTPS与循环辅助时间、手术时间、主动脉阻断时间、术后3 d疼痛程度、术后心绞痛显著正相关;与术毕是否实施镇痛显著负相关.结论 手术时间、术后急性疼痛和术后心绞痛是导致PTPS的危险因素.术后3年,发生率逐渐减低.     

Assessment of acute and chronic pain

Acute and chronic pain states overlap in chronology and pathophysiology but both can remain under-managed. Assessment aims to elucidate underlying diagnosis and/or pain generators that can then guide treatment strategies. Assessment should be repeated to assess efficacy of treatments and the presence of side effects. Self-report questionnaires are available to assist in diagnosis and monitoring of pain and its related dimensions but they do not replace a thorough assessment by an experienced clinician.     

A case-control study of risk factors in men with chronic pelvic pain syndrome

OBJECTIVE: To compare the demographic, behavioural, clinical and medical history characteristics of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and asymptomatic controls, to identify characteristics that might be associated with this syndrome. PATIENTS AND METHODS: Self-administered epidemiological questionnaires were completed by 463 men with CP/CPPS and 121 asymptomatic age-matched controls. We compared the prevalence of possible risk factors between men with CP/CPPS and controls, using generalized Mantel-Haenszel tests, and developed multivariate predictive models using logistic regression methods, adjusting for clustering by clinical centre within both methods. RESULTS: Compared to controls, men with CP/CPPS reported a significantly greater lifetime prevalence of nonspecific urethritis (12% vs 4%, P = 0.008), cardiovascular disease (11% vs 2%, P = 0.004), neurological disease (41% vs 14%, P < 0.001), psychiatric conditions (29% vs 11%, P < 0.001), and haematopoietic, lymphatic or infectious disease (41% vs 20%, P < 0.001). CONCLUSION: A wide range of self-reported medical conditions was associated with CP/CPPS. Further studies are necessary to determine whether they play a role in the pathogenesis of CP/CPPS.     

The risk factors in operative treatment of an acute and chronic surgical diseases

According to retrospective analysis of the surgical treatment of patients in presence of cardial risk factors it was established the absence of alternative for surgical intervention while choosing the treatment tactic in 80% of observations, in 16%--the necessity for relaparotomy performance. The direct cause of death in this patients was cardial insufficiency and coronary blood circulation insufficiency, and complications of principal abdominal surgical disease. To improve the results of treatment of this severely ill patients it is expedient to conduct one-stage and the staged surgical and cardiosurgical intervention.     

Assessment of acute and chronic pain

Acute and chronic pain states are under-recognized and under-treated. The assessment of pain and evaluation of treatment requires repeated measurement of pain intensity using reliable and well-validated scales. Sensory components of pain must also be assessed and in particular, the diagnosis of neuropathic pain should not be missed as this diagnosis may direct treatment and potentially alter long-term outcomes. Several neuropathic screening tools are available to aid the detection and monitoring of neuropathic pain but importantly, a clinical examination is essential to corroborate this diagnosis. The further assessment of chronic pain should involve a thorough assessment of global function and quality of life using reliable and well-validated screening tools. In particular, physical and emotional functioning should be monitored.     

Assessment of acute and chronic pain

Assessment of pain is essential for successful pain management. This article looks at the issues surrounding acute and chronic pain assessment, including the use of one-dimensional and multi-dimensional assessment scales in different pain states and different patient populations.     

The outcome of acute interstitial nephritis: risk factors for the transition from acute to chronic interstitial nephritis

BACKGROUND: Acute interstitial nephritis has been known as a complication of mainly streptococcal infection for nearly a century. With the advent of infection control, it became a complication caused by antibiotics and later by other drugs, which might have changed the outcome. To determine risk factors for the development of chronic renal insufficiency, and thus, the transition from acute to chronic interstitial nephritis, we performed a retrospective study of all cases of acute interstitial nephritis found by reviewing 1,068 renal biopsies from 1968 to 1997. METHODS: Patients with permanent and reversible renal insufficiency after acute interstitial nephritis were compared with respect to the causative event, the symptoms, and the clinical and histological findings. Differences between the groups were calculated by applying bi- and multivariate analysis. RESULTS: Acute interstitial nephritis was found in 6.5% of all biopsies (64 patients with 68 episodes of acute interstitial nephritis); it was infection-induced in 10%, idiopathic in 4%, and drug-induced in 85% of the cases (antibiotics in 13 cases, analgesics in 17, non-steroidal anti-inflammatory drugs (NSAIDs) in 16, diuretics in 5, and various other drugs in 7). Renal insufficiency was reversible in 69% and permanent in 31% (12% partially reversible, 19% irreversible). The infection-induced and idiopathic types of acute interstitial nephritis were always reversible. Drug-related acute interstitial nephritis caused permanent renal insufficiency in 36% with a maximum of 56% in NSAID-induced cases. In drug-induced cases, intake of the suspected drug for more than a month prior to diagnosis caused permanent renal insufficiency in 88% and interstitial granuloma in 31%. Multivariate analysis disclosed the following significant features separating the permanent from the reversible renal insufficiency group: patients in the first group had more tubular atrophy in their histology, more chronic use of mixed analgesics and/or NSAIDs, less oliguria or anuria as an acute symptom, fewer antibiotics as causative agents, more interstitial granuloma, more pronounced interstitial cell infiltration in their histology, and more imaging of renal shrinkage. Renal histology had the highest predictive value. CONCLUSION: Today, acute interstitial nephritis is mainly drug-induced. NSAIDs are the most frequent cause of permanent renal insufficiency after acute interstitial nephritis. Clinically, subacute symptoms, a prolonged intake of the suspect drug, and chronic analgesic or NSAID use are related to a more chronic course of interstitial nephritis. In histology, tubular atrophy, interstitial granuloma, and pronounced interstitial cell infiltration indicate chronicity.     

Medicines optimization in acute and chronic pain

Pain is a complex condition and warrants a multidisciplinary approach based on a bio-psycho-social model. Whilst often successful in acute pain, pharmacological treatment is rarely successful on its own in the management of chronic pain due to the high number of patients needed to treat to achieve a clinically meaningful improvement in function, quality of life and pain scores. There are also significant side effects in the short and long term. Recent re-analysis of clinic trial data focused on individual responder rates, showed that there is a cohort of patients who achieve 50% pain relief with subsequent improvement in physical function. To avoid intolerable side effects from medication used for chronic pain, titration needs to be slow and aimed towards the agreed risk–benefit between patients and treating physician with a clear plan for weaning and cessation if these goals are not achieved. Pain-orientated physiotherapy, either on its own or as part of a pain management programme, should be offered and medication reduced or weaned after restoration of function has been achieved.