术前疼痛灾难化和全膝关节置换术后慢性疼痛的相关性

目的 探讨膝骨关节炎(KOA)患者术前疼痛灾难化与全膝关节置换术(TKA)术后慢性疼痛(CPSP)的相关性。方法 选择2020年8月至2021年1月行首次单侧TKA患者240例,男105例,女135例,年龄45～64岁,BMI 18～30 kg/m²,ASAⅠ—Ⅲ级。根据是否发生术前疼痛灾难化将患者分为两组：灾难化组(n=78)和非灾难化组(n=162)。所有患者麻醉方法和手术方式一致。记录性别、年龄、BMI、ASA分级、K-L分级、KOA病程、术前合并心血管疾病、术前镇痛药物使用例数和术前1 d C-反应蛋白(CRP)浓度。术前1 d记录医院焦虑抑郁量表(HAD)、中枢敏化问卷(CSQ)和疼痛灾难化量表(PCS),若PCS评分≥30分认为发生疼痛灾难化。记录术中丙泊酚、瑞芬太尼、舒芬太尼用量、出血量、止血带使用时间、手术时间、补救镇痛例数、术后住院时间和术后6个月内使用非甾体抗炎药(NSAIDs)例数。记录术后6个月静息和活动时VAS疼痛评分,若术后6个月静息或(和)活动时VAS疼痛评分>3分记为发生CPSP。采用Poisson回归分析评估发生术前疼痛灾难...     

剖宫产切口妊娠患者子宫动脉栓塞术后疼痛相关因素分析

目的探讨剖宫产切口妊娠患者子宫动脉栓塞术后疼痛发生情况及其影响因素。方法对120例剖宫产切口妊娠患者在子宫动脉栓塞术后0、6、12、24h,采用数字疼痛评分法进行疼痛评估,收集疼痛相关因素(如术前测量疼痛敏感度、人口统计学资料及焦虑、抑郁等)。结果术后24h内中度及以上疼痛占58.33%;单因素分析显示,心理状态、疼痛敏感度、文化程度及手术时长是剖宫产切口妊娠患者子宫动脉栓塞术后中度及以上疼痛的相关因素(P0.05,P0.01)。结论子宫动脉栓塞术后疼痛发生率高,术前充分评估患者心理状态和实验性压力痛阈测试可用来预测术后患者疼痛,从而更好地管理和控制疼痛。     

疼痛灾难化对膝关节置换术后疗效的影响

目的分析疼痛灾难化对全膝关节置换(TKA)术后疗效的影响。方法对连续77例因骨关节炎(OA)行TKA术的患者进行分析。术前进行美国特种外科医院膝关节评分系统(HSS评分)及疼痛灾难化量表(PCS)评分检查。术后1年时,进行HSS评分检查及慢性疼痛分析。对术前HSS评分和术前PCS评分,术前HSS和术后HSS评分,术前PCS评分和术后HSS评分进行线性相关检验,对存在慢性疼痛和不存在慢性疼痛的患者进行非配对t检验。结果患者术前HSS评分与术前PCS评分存在中度负相关关系(r=-0.6939,P0.01)。患者术前HSS评分与术后HSS评分存在高度正相关关系(r=0.8132,P0.01)。患者术前PCS评分与术后HSS评分存在中度负相关关系(r=-0.7143,P0.01)。术后1年发生慢性疼痛患者8例,无慢性疼痛患者66例。术后慢性疼痛患者与无术后慢性疼痛患者的术前HSS评分(t=2.029,P0.05)和术前PCS评分(t=6.215,P0.01),存在统计学差异。结论拟行TKA的换患者存在明显的疼痛灾难化现象,并会对术后慢性疼痛的及关节功能产生影响。     

癌症患者疼痛灾难化研究进展

对癌症患者疼痛灾难化的内涵、核心评估工具、现状及影响因素、干预措施进行综述。提出疼痛灾难化是癌症患者疼痛行为的主要心理因素,疼痛灾难化研究对癌症患者的疼痛管理意义重大;未来应扩大疼痛灾难化研究领域中的癌症患者人群,研制特异性癌症患者疼痛灾难化评估工具,构建具有智能化元素的干预方案,以提高癌症患者疼痛管理质量。     

术后疼痛高危因素的分析

目的 探讨影响术后疼痛的高危因素,对术后早期疼痛的发生几率及严重程度做出预测.方法 选择本院手术患者2 859例,采用Logistic多项多元回归分析筛选出构成评分系统的影响因素;通过ROC曲线确定预测不同术后疼痛发生率的分值界点;采用Kappa检验比较评分系统预测的术后疼痛发生率与实际疼痛发生率的一致性.结果 Logistic多元回归分析提示:性别、年龄、术前VAS评分、术前焦虑评分、术前心率、手术类型、手术切口大小、麻醉方式、手术时间为影响术后疼痛的高危因素;术后VAS评分的曲线下面积是0.90±0.01(P<0.01);疼痛评分在2.5时,灵敏度为100%,特异度为78.9% ;Kappa指数为0.54.结论 术后疼痛预测模型简单实用,对临床有一定参考价值.     

疼痛灾难化在痛风患者自我效能感与整体疼痛评估间的中介效应

目的:探讨痛风患者疼痛灾难化在自我效能感与整体疼痛评估之间的中介效应.方法:抽取2020年8月至2021年3月在山东省痛风病临床医学中心就诊的痛风患者357例,采用疼痛自我效能感量表、疼痛灾难化量表、整体疼痛评估量表进行调查.采用SPSS 25.0软件分析痛风患者自我效能感、疼痛灾难化与整体疼痛评估的相关性,采用AMO...     

髋或膝关节置换术后急性疼痛的影响因素和预测模型

目的 探讨髋或膝关节置换术患者术后急性疼痛(APP)的影响因素,建立并验证预测模型。方法 收集行髋或膝关节置换术患者316例的临床资料,男111例,女205例,年龄≥18岁,ASAⅠ—Ⅲ级。根据是否发生APP将患者分为两组：非APP组和APP组。将患者按7∶3的比例随机分成训练集和验证集。通过LASSO回归和多因素Logistic回归分析训练集,筛选危险因素并构建预测模型,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)评估模型的预测效率。在验证集中,采用Bootstrap方法进行内部验证,采用临床决策曲线分析(DCA)评价预测模型的临床价值。结果 有137例(43.4%)患者发生APP。多因素Logistic回归分析显示,高BMI、糖尿病史、手术时间延长、疼痛灾难化评分≥27分是髋或膝关节置换术患者发生APP的独立危险因素(P<0.05),放置引流管、术前药物预防性镇痛、术后使用镇痛泵、术后行神经阻滞镇痛是髋或膝关节置换术患者发生APP的保护因素(P<0.05)。纳入BMI、糖尿病史、放置引流管、手术时间、疼痛灾难化评分构建预测模型,训练集的AUC为0.879(...     

下肢骨折术后疼痛原因分析与护理对策

目的为了解下肢骨折术后疼痛的相关因素，有针对性地加强术后疼痛的护理。方法利用“术前焦虑量表”及自行设计的“骨折术后疼痛原因调查表”，对100例下肢骨折手术患者进行问卷调查。结果术后造成疼痛的原因与术后天数密切相关（χ^2=283．25，P〈0．01）。术前焦虑与术后疼痛存在重度的正性相关（r=0．4226）。结论针对上述特点提出了通过术前心理护理，术后相应的护理措施和使用镇痛药物缓解术后疼痛的对策。     

成人术后急性疼痛评估工具的范围综述

目的 总结国内外术后急性疼痛评估工具，以期为今后相关研究提供参考。方法 系统检索中英文数据库、相关指南、协会网站，检索时限为建库至2022年8月1日。筛选符合纳入标准的术后疼痛评估工具，提取文献(标题、作者、国家、时间)及评估工具(名称、适用人群、评估内容、优缺点、信效度)的基本信息，进行分类汇总分析。结果 共纳入632篇文献，选取每个工具被引频次最高或最具代表性的文献进行分析，最后纳入31篇。筛选出31个术后疼痛评估相关工具，其中量表类18个、问卷类7个、客观生理监测指标类6个。按主题划分，评估术后疼痛程度相关工具共22个，评估术后镇痛效果及质量工具共9个。结论 术后疼痛评估工具种类繁多，各有其不同的适用范围及优缺点，建议医护人员合理权衡利弊，选取适宜的最优评估工具以获得客观的评估结果。同时，术后疼痛预测及超前干预研究国内尚处于起步阶段，未来还需进一步探索。     

疼痛灾难化量表

疼痛是一种感知觉和情感的复杂的复合体。疼痛有很重要的心理因素，疼痛灾难化是参与调节对疼痛行为反应的显著的心理因素。它被定义为一个信念体系、一种应对策略及在体验和感受疼痛时的一种评估过程。疼痛灾难化有3个因素：反复思虑、夸大和无助。疼痛灾难化的认知可以参与到疼痛的产生和维持过程中，来产生或加强和维持疼痛感受。     

Catastrophizing: a predictive factor for postoperative pain

Background

Postsurgical pain is a major cause of delayed recovery and discharge after surgery. A significant proportion of patients develop chronic postsurgical pain, which affects their quality of life. Cognitive and psychological factors are reported to play a significant role in the severity of reported postsurgical pain. High levels of catastrophizing are associated with a heightened pain experience and appear to contribute to the development of chronic pain. This article describes the concept of pain catastrophizing, its association with postsurgical pain, and its potential role in the management of postsurgical pain and postsurgical quality of life.

Methods

Data for this review were identified from MEDLINE, EMBASE, and PsycINFO. Reference lists of selected articles were cross-searched for additional literature.

Results

High catastrophizing levels were found to be associated with increased pain severity, increased incidence of development of chronic pain, and poorer quality of life after surgery. There was no consensus on the relation between catastrophizing and analgesia consumption.

Conclusions

Identifying and reducing catastrophizing levels can help to optimize pain management in surgical patients.     

开颅手术后疼痛管理的研究进展

开颅手术是最常见的神经外科手术之一。开颅术后中重度疼痛发生率高达75%,术后疼痛可增加术后并发症，延长ICU停留时间和住院时间，严重影响患者术后康复。部分镇痛方法和镇痛药物导致的恶心、呕吐、呼吸抑制等不良反应可能会影响患者术后的神经功能，掩盖神经系统症状，干扰病情判断，目前尚无针对开颅患者的确切镇痛方案。如何实施开颅患者术后镇痛，改善患者转归，成为临床亟待解决的问题。本文就开颅术后疼痛特点、疼痛机制、疼痛评估、镇痛策略与管理进行综述，以期为开颅手术的术后镇痛提供参考。     

Change in pain catastrophizing in patients with lumbar spinal surgery

Background Context

Even though catastrophizing can negatively moderate the outcome of surgery for lumbar spinal stenosis (LSS), it is still unclear whether pain catastrophizing is an enduring stable or a dynamic structure related to pain intensity after spine surgery.

The prognostic value of catastrophizing for predicting the clinical evolution of low back pain patients: a study in routine clinical practice within the Spanish National Health Service

Background contextExperimental studies suggest that catastrophizing may worsen the prognosis of low back pain (LBP) and LBP-related disability and increase the risk of chronicity.PurposeTo assess the prognostic value of baseline catastrophizing for predicting the clinical evolution of LBP patients in routine clinical practice and the association between the evolution of pain and catastrophizing.Study design/settingProspective study in routine clinical practice of the Spanish National Health Service.Patient sampleOne thousand four hundred twenty-two acute and chronic adult LBP patients treated in primary and hospital care.Outcome measuresPain, disability, and catastrophizing measured through validated instruments.MethodsPatients were managed according to routine clinical practice. Outcome measures were assessed at baseline and 3 months later. Logistic regression models were developed to estimate the association between baseline catastrophizing score and the improvement of LBP and disability, adjusting for baseline LBP and leg pain (LP) severity, disability, duration of the pain episode, workers' compensation coverage, radiological findings, failed back surgery, and diagnostic procedures and treatments undertaken throughout the study. Another model was developed to estimate the association between the evolution of LBP and the change in catastrophizing, adjusting for the same possible confounders plus the evolution of LP and disability. Models were repeated excluding the treatments undergone after the baseline assessment.ResultsRegression models showed that the degree of baseline catastrophizing does not predict the evolution of LBP and disability. Conversely, as the degree of pain improvement increases, so does the odds ratio for improvement in catastrophizing, ranging from three (95% confidence interval [95% CI], 2.00–4.50; p<.001) for improvements in pain between 1.1 and 4 visual analog scale (VAS) points, to 7.3 (95% CI, 3.49–15.36; p<.001) for improvements in pain more than 6.1 VAS points. Similar results were obtained when treatments were excluded from the models.ConclusionsIn routine practice, assessing the baseline score for catastrophizing does not help clinicians to predict the evolution of LBP and disability at 3 months.     

The chicken or the egg: Longitudinal changes in pain and catastrophizing in women with interstitial cystitis/bladder pain syndrome

IntroductionEvidence-based psychological strategies are being used as clinicians look for helpful interventions for patients diagnosed with the enigmatic chronic urological pelvic pain condition of interstitial cystitis/bladder pain syndrome (IC/BPS). Pain and pain catastrophizing are associated with chronic pelvic pain outcomes but the longitudinal role of catastrophizing on patient pain in IC/BPS remains unknown.MethodsWomen with IC/BPS were recruited from tertiary care clinics across North America and completed a battery of questionnaires, including demographics, pain, depression, catastrophizing at baseline, six months, and one year.ResultsA total of 226 patients completed baseline questions, 183 completed the six-month survey, and 151 completed the one-year survey. Using a cross-lagged analysis, early changes in pain catastrophizing predicted later changes in pain, but not vice versa. Followup subscale analyses revealed that early changes in magnification predicted later changes in pain, early changes in pain predicted later changes in rumination, and that there was a recursive relationship between changes in helplessness and changes in pain across the study.ConclusionsPain catastrophizing should be considered a prime target in psychological treatment for chronic pain in patients with IC/BPS, particularly those thinking styles associated with pain onset and maintenance. Future research should be conducted with constructs such as pain catastrophizing in samples prioritizing diversity of patients with IC/BPS and mechanisms as to how to effectively decrease catastrophizing.     

Effect of Preoperative Modifiable Psychological and Behavioural Factors on Early Outcome Following Total Knee Arthroplasty in an Indian Population

BackgroundNon-surgical factors have been found to have significant impact on outcome following Total Knee Arthroplasty (TKA). The study was conducted to know the independent effect of each of the four interacting psychological factors: anxiety, depression, pain catastrophizing and kinesiophobia on early outcome following TKA in an Indian population.Materials and Methods104 consecutive patients undergoing TKA were included in the study and followed up at 6 weeks, 6 months and one year. Preoperatively, Hospital Anxiety and Depression Scale was used to diagnose and quantify anxiety and depression, pain catastrophizing and kinesiophobia were assessed using Pain Catastrophizing Scale and Tampa Scale for Kinesiophobia, respectively. Outcome was assessed on the basis of Knee Society Score and Knee Injury and Osteoarthritis Outcome Score. Regression analysis was done to know independent effect of each factor on outcome scores.ResultsNine (8.7%) patients were found to have undiagnosed psychopathology. The patients with psychopathologies were found to have significantly worse knee outcome scores on follow-up, although the rate of improvement in knee symptoms and function was not significantly different from those without psychopathology. The degree of Anxiety correlated with worse knee pain and stiffness up to 6 months while it correlated with poor knee function for a longer duration. The degree of depression and pain catastrophizing correlated with worse knee pain, stiffness and function at all visits while kinesiophobia didn’t show correlation independent other factors.ConclusionPsychopathology was found to be associated poor knee outcome scores with degree of preoperative depression and pain catastrophizing as significant independent predictors as poor outcome, whereas the effect of degree of anxiety on knee pain and stiffness was found to wane over time. Kinesiophobia didn’t show any independent correlation.Supplementary InformationThe online version of this article (10.1007/s43465-020-00325-x) contains supplementary material, which is available to authorized users.     

术前痛阈和耐痛阈与妇科手术后芬太尼消耗量的关系

目的 评价妇科手术病人术前痛阈、耐痛阈与术后芬太尼消耗量之间的关系.方法 择期全麻下行子宫肌瘤剔除术或子宫全切术病人44例,年龄20～50岁,ASA Ⅰ或Ⅱ级.麻醉诱导前采用电刺激仪测定痛阈和耐痛阈;静脉注射咪达唑仑、瑞芬太尼、异丙酚和琥珀胆碱麻醉诱导;麻醉维持:静脉输注瑞芬太尼和异丙酚,静脉注射阿曲库铵;术后采用芬太尼混合氟哌利多行病人自控静脉镇痛,背景输注速率0.5 ml/h,PCA量2 ml,锁定时间5 min.记录术毕和术后24 h VAS评分、术后24 h镇痛泵有效按压次数和芬太尼消耗量.术前痛阈和耐痛阈与术后镇痛泵有效按压次数和芬太尼消耗量进行直线相关分析.结果 术前痛阈与术后24 h镇痛泵有效按压次数和芬太尼消耗量的相关性无统计学意义(P0.05).术前耐痛阈与术后24 h镇痛泵有效按压次数和芬太尼消耗量呈负相关,r分别为-0.71、-0.70(P<0.05).结论 术前痛阈不能预测妇科手术后芬太尼消耗量,但术前耐痛阈可以预测.     

Association between Shoulder Range of Motion and Pain Catastrophizing Scale in Breast Cancer Patients after Surgery

BackgroundProlonged survival period as a result of early diagnosis and treatment in breast cancer has increased the importance of postoperative morbidities. The aim of the present study was to investigate the association of pain ca­tastrophizing with shoulder pain in patients with decreased shoulder range of motion in the postoperative period.Patients and MethodsThe present study included 53 patients who underwent surgery due to breast cancer. Patients who had bilateral mastectomy, distant metastases, cervical-cranial originated lesions, patients with problems involving one of the shoulders or upper extremities before the operation, and patients with cognitive impairment, heart failure, or low albumin levels (liver parenchyma disease or renal failure) were excluded. Shoulder range of motion was measured in the postoperative period, and two study groups were established: one with a limited shoulder range of motion level and the other with a normal level. Effects of pain catastrophizing and shoulder pain severity on shoulder range of motion limitation were compared between the two groups.ResultsThe average age of 53 female patients who had breast surgery was 52.3 ± 10.5 years. In the group with limited shoulder range of motion, the median pain catastrophizing scale value was 27 (range 5–32) and the shoulder pain severity score was 4 (range 0–8), while in the group with normal shoulder range of motion these values were 11 (range 3–39) and 2 (range 0–6), respectively (p < 0.05). In addition, it was found that factors such as surgical treatment modality and postoperative radiotherapy did not significantly affect shoulder range of motion limitation.ConclusionDetermining the pain catastrophizing scale of patients and controlling pain in the early postoperative period could have positive effects on shoulder range of motion.     

Preoperative pain catastrophizing affects pain outcome after total knee arthroplasty

BackgroundsPreoperative widespread pain sensitization or pain catastrophizing could be associated with chronic pain after total knee arthroplasty (TKA). The aim of the present study was to examine the association between postoperative pain in patients undergoing TKA and preoperative factors, including patient characteristics and preoperative central sensitization as well as pain catastrophizing.MethodsPreoperative TKA patients were evaluated using the Central Sensitization Inventory (CSI)-9 and Pain Catastrophizing Scale (PCS). Postoperative knee pain was evaluated using a numerical rating scale (NRS) 6 months after TKA. Statistical analyses were performed to assess the relationship between NRS 6 months after TKA and preoperative factors, including patient characteristics, CSI-9, and PCS.ResultsWe enrolled 58 consecutive patients with osteoarthritis who underwent TKA. Using cutoff of 14, postoperative NRS was higher in the patients with ≥14 than the patients with <14 in CSI (p = 0.025). Postoperative NRS was higher in the patients with ≥30 than the patients with <30 in PCS (p = 0.043). Preoperative PCS was a significant risk factor of postoperative pain using a multivariate analysis.ConclusionsSurgeon should recognize preoperative PCS could affect postoperative pain 6 months after TKA.