Trajectories of postsurgical pain in children: risk factors and impact of late pain recovery on long-term health outcomes after major surgery.
Trajectories of postsurgical pain in children: risk factors and impact of late pain recovery on long-term health outcomes after major surgery.
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DOI：
10.1097/j.pain.0000000000000281
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发表时间：
2015-11
期刊：
影响因子：
7.4
通讯作者：
Palermo TM
中科院分区：
文献类型：
--
作者：
Rabbitts JA;Zhou C;Groenewald CB;Durkin L;Palermo TM
在美国，每年有超过 100 万儿童接受住院手术。最新研究表明，许多儿童存在长期疼痛问题。然而，关于疼痛随时间的推移以及疼痛恢复对长期健康结果的影响的数据有限。我们试图通过 12 个月内的重复评估来前瞻性地描述儿童的术后疼痛轨迹。此外，我们还确定了与持续性疼痛相关的术前儿童和家长心理危险因素，并检查了疼痛轨迹与长期健康结果之间的关系。 60 名 10 至 18 岁接受大手术的儿童及其父母/监护人被纳入研究。参与者在 5 个时间点完成评估：术前、住院、术后 2 周、4 个月和 1 年。在手术前一周评估儿童和家长的疼痛灾难性。儿童通过电子疼痛日记完成日常监测，并报告疼痛特征、健康相关的生活质量和活动限制。基于组的纵向模型揭示了两种不同的术后疼痛轨迹：早期恢复（n 5·49，82％）和晚期恢复（n 5·11，18％）。在控制年龄和性别的逻辑回归模型中，手术前父母的灾难性疼痛显着预测了晚期恢复组的成员资格（比值比 5 1.11，P 5 0.03），而儿童的灾难性疼痛和基线疼痛则不然（Ps，0.05）。在控制年龄和性别的多变量回归中，晚期疼痛恢复与 1 年时较差的健康相关生活质量 (b 5 210.7，P 5 0.02) 和更大的活动限制 (b 5 3.6，P 5 0.04) 显着相关。我们的研究结果表明，改变父母行为和认知的术前干预可能对该人群有益。
Over 1 million children undergo inpatient surgery annually in the United States. Emerging research indicates that many children have longer-term problems with pain. However, limited data exist on the course of pain over time and the impact of pain recovery on longterm health outcomes. We sought to prospectively characterize children’s postsurgical pain trajectories using repeated assessments over 12 months. In addition, we identified presurgical child and parent psychological risk factors associated with persistent pain and examined relationships between pain trajectories and long-term health outcomes. Sixty children aged 10 to 18 years undergoing major surgery and their parent/guardian were enrolled. Participants completed assessments at 5 time points: presurgery, inhospital, 2 weeks, 4 months, and 1 year postsurgery. Child and parent pain catastrophizing was assessed during the week before surgery. Children completed daily monitoring with an electronic pain diary and reported on pain characteristics, healthrelated quality of life, and activity limitations. Group-based longitudinal modeling revealed 2 distinct trajectories of postsurgical pain: early recovery (n 5 49, 82%) and late recovery (n 5 11, 18%). In a logistic regression model controlling for age and sex, parental pain catastrophizing before surgery significantly predicted membership in the late recovery group (odds ratio 5 1.11, P 5 0.03), whereas child catastrophizing and baseline pain did not (Ps, 0.05). In a multivariate regression controlling for age and sex, late pain recovery was significantly associated with poorer health-related quality of life (b 5 210.7, P 5 0.02) and greater activity limitations (b 5 3.6, P 5 0.04) at 1 year. Our findings suggest that preoperative interventions that modify parent behaviors and cognitions might be beneficial in this population.