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首页> 外文期刊>The journal of pain: official journal of the American Pain Society >Postoperative pain trajectories in chronic pain patients undergoing surgery: The effects of chronic opioid pharmacotherapy on acute pain
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Postoperative pain trajectories in chronic pain patients undergoing surgery: The effects of chronic opioid pharmacotherapy on acute pain

机译：接受手术的慢性疼痛患者的术后疼痛轨迹：慢性阿片类药物治疗对急性疼痛的影响

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For 2 weeks following surgery, 55 patients with preexisting chronic pain (CP) reported daily postoperative pain with movement and at rest. Of these, 30 CP patients used opioid pharmacotherapy for CP management and 25 did not. We modeled pain resolution in each patient using a linear fit so that each patient yielded 2 scores for each pain rating: 1) an intercept, or initial level of pain, immediately after surgery; and 2) a slope, or rate of pain resolution. The patients not using opioid pharmacotherapy had a mean pain with movement intercept of 5.4 and a slope of -.20, while the patients using opioid pharmacotherapy had a significantly higher mean intercept of 7.68 (P =.001) and a slope of -.21, sustaining higher pain levels over days. The opioid pharmacotherapy patients had the same rate of pain resolution as the other CP patients, and both groups resolved their pain more slowly than normal surgery patients. Preexisting CP may predispose a patient undergoing surgery to a slower rate of postoperative pain resolution. Chronic pain patients who use opioids share this predisposition but in addition, they are at risk for markedly higher postoperative pain across the entire pain resolution trajectory. Perspective: This is an observational rather than a randomized controlled study, and as such is less definitive. Nonetheless, these findings are consistent with those of animal studies showing that prolonged exposure to opioids can produce opioid-induced hyperalgesia. Patients with opioid pharmacotherapy for chronic pain who undergo surgery merit special attention for acute pain management.
机译：手术后2周内，有55名既往患有慢性疼痛（CP）的患者报告其术后每天运动和休息时出现疼痛。在这些患者中，有30位CP患者使用阿片类药物进行CP治疗，而25位则没有。我们使用线性拟合对每位患者的疼痛缓解进行建模，以使每位患者的每种疼痛等级获得2分：1）手术后立即进行截距或初始疼痛水平; 2）坡度或疼痛缓解率。未使用阿片类药物治疗的患者的平均疼痛平均运动截距为5.4，斜率为-.20，而未使用阿片类药物治疗的患者的平均疼痛平均截距为7.68（P = .001），斜率为-.21。 ，持续数日承受更高的疼痛水平。阿片类药物治疗患者的疼痛缓解率与其他CP患者相同，两组的疼痛缓解速度均比正常手术患者慢。预先存在的CP可能会使接受手术的患者的术后疼痛缓解率降低。使用阿片类药物的慢性疼痛患者也有这种倾向，但此外，他们在整个疼痛缓解轨迹中都有明显更高的术后疼痛风险。观点：这是一项观察性研究，而非随机对照研究，因此确定性较低。尽管如此，这些发现与动物研究一致，动物研究表明长期接触阿片类药物可引起阿片类药物引起的痛觉过敏。需接受阿片类药物慢性疼痛药物治疗且需要手术治疗的患者特别需要注意急性疼痛的治疗。

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