Improving Individual Measurement of Postoperative Pain: The Pain Trajectory
Improving Individual Measurement of Postoperative Pain: The Pain Trajectory
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DOI：
10.1016/j.jpain.2010.08.005
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发表时间：
2011-02-01
期刊：
影响因子：
4
通讯作者：
Bradshaw, David H.
中科院分区：
文献类型：
--
作者：
Chapman, C. Richard;Donaldson, Gary W.;Bradshaw, David H.
本研究的目的是证明一种提高术后疼痛评估的精确度和信息量的方法。我们记录了502名择期手术患者术后6天以上的疼痛强度等级，并检查了个体疼痛轨迹。单个患者得分的线性拟合定义了具有两个特征的轨迹：(1)截取或初始疼痛强度；(2)斜率，或疼痛解决率。通过对疼痛轨迹斜率的检查，出现了三种疼痛轨迹模式。大多数患者(63%的样本)表现为负斜率轨迹，其特征是术后数天内疼痛强度下降。其他患者(占样本的25%)在最初报告的疼痛后6天内显示出平坦的轨迹，没有明显的变化。第三组患者(占样本的12%)在术后6天内疼痛评分增加，呈正斜率轨迹。由个体疼痛轨迹得出的测量结果的测量标准误差要低得多，因此比传统的疼痛评估方法具有更好的测量精度。疼痛轨迹测量被证明足够精确，可以可靠地描述个体患者的疼痛模式。观点：急性疼痛管理的进展需要有效的疼痛评估。急性疼痛轨迹量化了疼痛解决率和疼痛强度。它提供了比传统的疼痛评估更精确的测量，并可以识别异常的术后疼痛解决。(C)2011年，美国疼痛协会
The purpose of this study was to demonstrate a method for increasing the precision and information yield of postoperative pain assessment. We recorded pain intensity ratings over 6 days after surgery in 502 elective surgery patients and examined individual pain trajectories. A linear fit of an individual patient's scores defines a trajectory with two features: (1) the intercept or initial pain intensity; and (2) the slope, or rate of pain resolution. Three pain trajectory patterns emerged from examination of the pain trajectory slopes. Most patients (63% of the sample) demonstrated a negative slope trajectory characterized by a decline in pain intensity over days after surgery. Other patients (25% of the sample) demonstrated a flat trajectory with no meaningful change over 6 days from pain they reported initially. A third patient group (12% of the sample) had a positive slope trajectory in which pain scores increased over 6 days after surgery. Measures derived from individual pain trajectories yielded much lower standard errors of measurement and therefore had better measurement precision than did conventional pain assessment methods. Pain trajectory measures proved sufficiently precise to characterize pain patterns reliably in individual patients.Perspective: Progress in acute pain management requires effective pain assessment. The acute pain trajectory quantifies rate of pain resolution as well as pain intensity. It affords more precise measurement than conventional pain assessment and can identify abnormal postoperative pain resolution. (C) 2011 by the American Pain Society