Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery.
Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery.
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DOI：
10.1097/pr9.0000000000000976
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发表时间：
2021-11
期刊：
影响因子：
4.8
通讯作者：
Schreiber KL
中科院分区：
文献类型：
--
作者：
Flowers KM;Beck M;Colebaugh C;Haroutounian S;Edwards RR;Schreiber KL
补充数字内容在文本中可用。检查术后麻木与阳性神经病性症状的患病率和预测因子的差异，可以深入了解患者经历的临床术后疼痛的变化。手术后可能会出现阳性（烧灼感、刺痛和异常性疼痛）和阴性（麻木）神经病性症状，但可能对患者术后疼痛体验的影响不同。麻木已被确定为与阳性神经性症状不同，因此从一些神经性评估工具中排除（术后患者神经性疼痛量表[NeuPPS]）。在这项对接受乳腺手术的患者进行的前瞻性纵向研究中，我们旨在描述麻木的时间进程及其与NeuPPS的一致性，并对比手术、心理社会和心理物理预测因素与阴性与阳性神经病性症状发展的相关性。患者在术后2周、3、6和12个月报告了手术区域感觉障碍。使用广义估计方程线性和logistic回归研究了基线人口统计学、手术、心理社会和心理物理因素与NeuPPS和麻木随时间的相关性。65%的患者持续报告麻木;阳性神经性症状不太常见，通常随时间推移而减少。一半患者同时出现术后神经性疼痛量表评分和麻木，均与更严重的临床疼痛和影响、年轻、腋窝手术和心理社会因素相关。更广泛的手术和化疗只与麻木有关。相反，其他慢性疼痛、体力活动减少、围手术期阿片类药物使用、负面影响以及基线压痛阈值和耐受性降低仅与NeuPPS相关。仅报告麻木的患者并不支持实质性的临床疼痛。在乳腺手术患者中，麻木与NeuPPS的预测因子、患病率和时间进程的差异显示了重要的区别，这表明在未来的术后疼痛研究中，他们的独立评估是值得的。
Supplemental Digital Content is Available in the Text. Examining the divergence of prevalence and predictors of postsurgical numbness vs positive neuropathic symptoms gives insights into variation in clinical postoperative pain experienced by patients. Both positive (burning, stabbing, and allodynia) and negative (numbness) neuropathic symptoms may arise after surgery but likely contribute differently to patients' postoperative pain experience. Numbness has been identified as divergent from positive neuropathic symptoms and therefore excluded from some neuropathic assessment tools (Neuropathic Pain Scale for PostSurgical patients [NeuPPS]). In this prospective longitudinal study of patients undergoing breast surgery, we aimed to delineate the time course of numbness and its coincidence with NeuPPS and to contrast the association of surgical, psychosocial, and psychophysical predictors with the development of negative vs positive neuropathic symptoms. Patients reported surgical area sensory disturbances at 2 weeks and 3, 6, and 12 months postoperatively. Association of baseline demographic, surgical, psychosocial, and psychophysical factors with NeuPPS and numbness across time was investigated using generalized estimating equation linear and logistic regression. Numbness was consistently reported by 65% of patients; positive neuropathic symptoms were less common, often decreasing over time. Neuropathic Pain scale for PostSurgical patients and numbness co-occurred in half of patients and were both associated with greater clinical pain severity and impact, younger age, axillary surgery, and psychosocial factors. More extensive surgery and chemotherapy were only associated with numbness. Conversely, other chronic pain, lower physical activity, perioperative opioid use, negative affect, and lower baseline pressure pain threshold and tolerance were only associated with NeuPPS. Patients reporting numbness alone did not endorse substantial clinical pain. Differentiation of predictors, prevalence, and time course of numbness vs NeuPPS in breast surgical patients revealed important distinctions, suggesting that their independent assessment is worthwhile in future studies of postsurgical pain.