A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents.
A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents.
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DOI：
10.2147/jpr.s239320
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发表时间：
2020
影响因子：
2.7
通讯作者：
Lang EA
中科院分区：
文献类型：
--
作者：
Rabbitts JA;Palermo TM;Lang EA
急性和慢性疼痛是手术在整个生命周期中非常普遍和有影响的后果，但缺乏一个全面的概念模型，包括潜在的急性到慢性疼痛转变的生物心理社会因素，特别是在年轻人中。在先前的慢性术后疼痛模型的基础上，我们提出了从急性到慢性术后疼痛过渡的生物心理社会机制的新概念模型。本综述旨在总结现有的研究，探讨急性到慢性手术后疼痛转变的关键因素，以指导预防和干预工作，旨在解决儿童这一健康问题。当疼痛从急性伤害性疼痛转变为慢性疼痛时，外周和中枢神经系统的变化有助于手术后疼痛的慢性化。这些变化包括感觉疼痛处理和社会心理过程（心理、行为和社会成分）的改变，它们促进了慢性疼痛的发展。患者相关的病前因素（如人口统计学因素、遗传谱和病前疼痛等医学因素）可能进一步调节这些变化。与急性损伤和恢复相关的因素（如手术和治疗因素）以及对手术的生物反应（如表观遗传、炎症和内分泌因素）也可能影响这一过程。总的来说，纵向研究包括风险和弹性因素在内的生物心理社会过程的时间通路对于确定从急性疼痛到慢性疼痛过渡的机制至关重要。研究还需要揭示急性疼痛体验、阿片类药物暴露和急性到慢性疼痛转变过程中感觉疼痛加工之间的联系。此外，未来的研究应包括更大、更多样化的样本，以更充分地探索更广泛的儿科手术的危险因素。使用概念模型来指导针对从急性到慢性疼痛过渡机制的干预方法将显著推进这一领域，并改善接受手术的儿童和青少年的预后。
Acute and chronic pain are highly prevalent and impactful consequences of surgery across the lifespan, yet a comprehensive conceptual model encompassing biopsychosocial factors underlying acute to chronic pain transition is lacking, particularly in youth. Building on prior chronic postsurgical pain models, we propose a new conceptual model of biopsychosocial mechanisms of transition from acute to chronic postsurgical pain. This review aims to summarize existing research examining key factors underlying acute to chronic postsurgical pain transition in order to guide prevention and intervention efforts aimed at addressing this health issue in children. As pain transitions from acute nociceptive pain to chronic pain, changes in the peripheral and central nervous system contribute to the chronification of pain after surgery. These changes include alterations in sensory pain processing and psychosocial processes (psychological, behavioral, and social components), which promote the development of chronic pain. Patient-related premorbid factors (eg, demographic factors, genetic profile, and medical factors such as premorbid pain) may further modulate these changes. Factors related to acute injury and recovery (eg, surgical and treatment factors), as well as biological response to surgery (eg, epigenetic, inflammatory, and endocrine factors), may also influence this process. Overall, longitudinal studies examining temporal pathways of biopsychosocial processes including both risk and resiliency factors will be essential to identify the mechanisms involved in the transition from acute to chronic pain. Research is also needed to unravel connections between the acute pain experience, opioid exposure, and sensory pain processing during acute to chronic pain transition. Furthermore, future studies should include larger and more diverse samples to more fully explore risk factors in a broader range of pediatric surgeries. The use of conceptual models to guide intervention approaches targeting mechanisms of transition from acute to chronic pain will significantly advance this field and improve outcomes for children and adolescents undergoing surgery.