Pain trajectories and neuropathic pain symptoms following lung cancer surgery: A prospective cohort study

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-03-25 DOI:10.1002/ejp.2265

A. V. Danielsen, J. J. Andreasen, B. Dinesen, J. Hansen, K. K. Petersen, K. S. Duch, J. Bisgaard, C. Simonsen, L. Arendt-Nielsen

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Abstract

Background

Persistent postsurgical pain (PPSP) after lung cancer surgery is common and current definitions are based on evaluations at a single time point after surgery. Pain intensity and symptoms may however fluctuate and change over time, and be impacted by multiple and shifting factors. Studies of postoperative recovery patterns and transition from acute to chronic pain are needed for further investigation of preventive measures and treatments to modify unfavourable recovery paths.

Methods

In this explorative study, 85 patients undergoing surgery due to either presumptive or confirmed lung cancer reported pain intensities bi-monthly for 12 months. Pain trajectories during recovery were investigated, using group-based trajectory modelling. Associations with possible risk factors for PPSP, including clinical variables and anxiety and depression score (HADS), were also explored.

Results

A trajectory model containing three 12-month pain recovery groups was computed. One group without PPSP fully recovered (50%) within two to three months. Another group with mild-intensity PPSP followed a protracted recovery trajectory (37%), while incomplete recovery was observed in the last group (13%). Acute postoperative pain and younger age were associated with a less favourable recovery trajectory. More neuropathic pain symptoms were observed in patients with incomplete recovery.

Conclusions

Three clinically relevant recovery trajectories were identified, based on comprehensive pain tracking. Higher acute postoperative pain intensity was associated with an unfavourable pain recovery trajectory.

Significance Statement

Understanding the transition from acute to chronic postoperative pain and identifying preoperative risk factors is essential for the development of targeted treatments and the implementation of preventive measures. This study (1) identified distinct recovery trajectories based on frequent pain assessment follow-ups for 12 months after surgery and (2) evaluated risk factors for unfavourable postoperative pain recovery paths. Findings suggest that early higher postoperative pain intensity is associated with an unfavourable long-term recovery path.

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肺癌手术后的疼痛轨迹和神经性疼痛症状：前瞻性队列研究

背景：肺癌术后持续性疼痛（PPSP）很常见，目前的定义基于术后单个时间点的评估。然而，疼痛强度和症状可能会随着时间的推移而波动和变化，并受到多种因素的影响。需要对术后恢复模式以及从急性疼痛到慢性疼痛的转变进行研究，以便进一步调查预防措施和治疗方法，改变不利的恢复路径：在这项探索性研究中，85 名因推测或确诊肺癌而接受手术的患者在 12 个月内每两个月报告一次疼痛强度。研究采用基于群体的疼痛轨迹模型，对患者康复期间的疼痛轨迹进行了调查。此外，还探讨了 PPSP 与可能的风险因素（包括临床变量和焦虑抑郁评分（HADS））之间的关联：结果：计算出了一个包含三个 12 个月疼痛恢复组的轨迹模型。其中一组没有 PPSP，但在两到三个月内完全康复（50%）。另一组有轻度 PPSP 的患者的恢复轨迹较长（37%），而最后一组患者的恢复不完全（13%）。急性术后疼痛和年轻与较差的恢复轨迹有关。在恢复不完全的患者中观察到更多的神经病理性疼痛症状：结论：根据全面的疼痛追踪，确定了三种与临床相关的恢复轨迹。急性术后疼痛强度较高与不利的疼痛恢复轨迹相关：意义说明：了解术后疼痛从急性到慢性的转变过程并确定术前风险因素，对于制定有针对性的治疗方法和实施预防措施至关重要。本研究(1)根据术后 12 个月内频繁的疼痛评估随访确定了不同的恢复轨迹，(2)评估了不利于术后疼痛恢复路径的风险因素。研究结果表明，早期较高的术后疼痛强度与不利的长期恢复路径有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.