Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery
Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery
复制标题
DOI：
10.3171/2017.5.spine1734
复制
发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Naik, Bhiken I.
中科院分区：
文献类型：
--
作者：
Dunn, Lauren K.;Durieux, Marcel E.;Naik, Bhiken I.
目的：围手术期疼痛知觉受多种心理因素的影响。本研究的目的是为了确定灾难、焦虑和抑郁对成人脊柱手术患者院内阿片类药物消耗、疼痛评分和康复质量的影响。方法本研究以脊柱手术患者为研究对象，术前完成的问卷包括言语评定量表(VRS)、疼痛灾变量表(PCS)、医院焦虑和抑郁量表(HADS)和嗅觉功能障碍指数(ODI)。采用康复质量问卷(QOR40)对康复质量进行评估。每天记录阿片类药物用量和疼痛评分，直到出院。结果139名患者参与研究，其中101人完成了术后QOR40评估。灾难性评分越高的患者术后最大疼痛评分越高(估计：0.03，SE：0.01，p=0.02)，而没有增加阿片类药物的使用(估计：0.44，SE：0.27，p=0.11)。术前焦虑(估计：1.18，SE：0.6 5，p=0.0 7)和抑郁评分(估计：1.0 6，SE：0.71，p=0.14)与术后阿片类药物使用的增加无关；然而，术前抑郁评分较高的患者术后恢复质量较低(估计：-1.9，SE：0.56，p<；0.001)。术前评估这些因素，利用一种有效的工具，有助于识别处于危险中的患者。这可能会允许更早的心理干预，从而降低疼痛严重程度，提高康复质量。
OBJECTIVE Perception of perioperative pain is influenced by various psychological factors. The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery.METHODS Patients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Quality of recovery was assessed using the 40-item Quality of Recovery questionnaire (QoR40). Opioid consumption and pain scores according to the VRS were recorded daily until discharge.RESULTS One hundred thirty-nine patients were recruited for the study, and 101 completed the QoR40 assessment postoperatively. Patients with higher catastrophizing scores were more likely to have higher maximum pain scores postoperatively (estimate: 0.03, SE: 0.01, p = 0.02), without increased opioid use (estimate: 0.44, SE: 0.27, p = 0.11). Preoperative anxiety (estimate: 1.18, SE: 0.65, p = 0.07) and depression scores (estimate: 1.06, SE: 0.71, p = 0.14) did not correlate with increased postoperative opioid use; however, patients with higher preoperative depression scores had lower quality of recovery after surgery (estimate: -1.9, SE: 0.56, p < 0.001).CONCLUSIONS Catastrophizing, anxiety, and depression play important roles in modulating postoperative pain. Preoperative evaluation of these factors, utilizing a validated tool, helps to identify patients at risk. This might allow for earlier psychological intervention that could reduce pain severity and improve the quality of recovery.