Older Age as a Prognostic Factor of Attenuated Pain Recovery After Shoulder Arthroscopy.
Older Age as a Prognostic Factor of Attenuated Pain Recovery After Shoulder Arthroscopy.
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DOI：
10.1016/j.pmrj.2015.09.004
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发表时间：
2016-04
期刊：
影响因子：
--
通讯作者：
George SZ
中科院分区：
文献类型：
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作者：
Simon CB;Riley JL 3rd;Coronado RA;Valencia C;Wright TW;Moser MW;Farmer KW;George SZ
肩部疼痛和手术在老年人中很常见。然而，年龄较大对肩关节手术后恢复的影响程度尚不清楚。评估年龄较大对肩关节镜术后3个月和6个月恢复因素的影响。前瞻性队列研究机构便利样本，包括139名年龄在20 - 79岁之间的个体，根据成像和医生评估，这些个体出现肩关节疼痛、肌肉骨骼功能障碍，并计划进行关节镜肩关节手术。使用ANOVA模型比较了术前、术后3个月和6个月时年轻、中年和老年人的术后结局。在每个时间点评估运动诱发的疼痛和疼痛处理的实验室相关性。在考虑术前、术中和术后预后因素后，通过多变量回归分析确定年龄对3个月和6个月疼痛结局的影响。与年轻人和中年人相比，老年人在三个月时具有更高的运动诱发疼痛强度（F2，108 = 5.18，p=.007）和实验疼痛反应（F2，111 = 7.24，p=.001）。在控制了关键预后因素后，年龄较大仍然是三个月运动诱发疼痛（R2= 0.05; St. Beta= 0.263，p= 0.031）和实验性疼痛反应（R2= 0.07; St. Beta= 0.295，p= 0.014）的阳性预测因子。此外，年龄较大仍然是6个月时运动诱发疼痛的积极预测因素（R2= 0.04; St. Beta= 0.231，p= 0.004），尽管结果没有年龄组差异。研究发现，年龄较大是三个月和六个月运动诱发疼痛的最强预测因素。老年人在肩关节镜检查后的最初几个月可能会经历更多与运动相关的疼痛以及内源性疼痛激发。未来的年龄相关研究应考虑使用运动诱发的疼痛强度和实验性疼痛反应作为疼痛结局，以及这些措施在临床护理中的效用。
Shoulder pain and surgery are common among older adults. However, the extent to which older age affects recovery after shoulder surgery is not well understood. To assess influence of older age on post-operative recovery factors three and six months after shoulder arthroscopy. Prospective Cohort Study Institutional Convenience sample of 139 individuals between 20 and 79 years of age who experienced shoulder pain, musculoskeletal dysfunction based on imaging and physician assessment, and were scheduled for an arthroscopic shoulder procedure. Post-operative outcomes were compared among younger, middle-aged and older adults at pre-surgery, 3 months and 6 months after surgery using ANOVA modeling. Movement-evoked pain and an experimental laboratory correlate of pain processing were assessed at each time point. Older age influence on three and six month pain outcomes were determined via multivariate regression analyses after accounting for pre-operative, intra-operative, and post-operative prognostic factors. Older adults had higher movement-evoked pain intensity (F2,108 = 5.18, p=.007) and experimental pain response (F2,111 = 7.24, p=.001) at three months compared to young and middle-aged adults. After controlling for key prognostic factors, older age remained a positive predictor of three-month movement-evoked pain (R2=.05; St. Beta=.263, p=.031) and experimental pain response (R2=.07; St. Beta=.295, p=.014). Further, older age remained a positive predictor of movement-evoked pain at six months (R2=.04; St. Beta=.231, p=.004), despite no age group differences in outcome. Older age was found to be the strongest predictor of three and six month movement-evoked pain. Older adults may experience more pain related to movement as well as endogenous pain excitation in the first few months after shoulder arthroscopy. Future age-related research should consider use of movement-evoked pain intensity and experimental pain response as pain outcomes, as well as the utility of such measures in clinical care.