一种定量感官检测方法在乳腺癌手术患者疼痛处理中的研究
Summary
持续的后疼痛可能与疼痛处理的变化有关。通过评估对标准化刺激的反应疼痛, 可以阐明疼痛处理的变化。我们提出的方法, 以获得不同刺激的疼痛阈值和一项措施内源性镇痛的病人进行乳腺癌手术。
Abstract
慢性疼痛后手术, 持续后疼痛, 是一个重要的高度普遍的情况下, 造成重大症状负担和降低生活质量。持续的后疼痛是相对顽固的治疗, 因此产生了很高的需要预防策略和治疗。因此, 确定患持续性疼痛的风险患者是一个积极进行的研究领域。最近有人证实, 中心疼痛处理的围手术期中断可能能够预测乳腺癌患者长期随访的持续后疼痛。本报告的目的是提出一个简短的协议, 以获得不同的刺激在多个地点的疼痛阈值, 并在乳腺癌患者的内源性镇痛措施。我们在临床上成功地运用了这一方法, 并从临床研究中得到了一些有代表性的结果。
Introduction
慢性疼痛后手术, 持续后疼痛, 是一个重要的条件, 导致严重的症状负担和较低的生活质量1。持续的手术后疼痛仍未得到很好的理解, 但被广泛认为是手术后3月以上的疼痛2。这种情况是常见的, 其患病率的估计范围从10% 到50% 的所有后患者3。高危程序包括乳房手术4、开胸术的5、截肢6和疝气修复7。持续的后疼痛是相对难治的治疗, 从而引起了潜在的预防策略和治疗的兴趣。更好地了解预测和描述持续的术后疼痛, 将有助于确定可能需要额外治疗的患者的子集, 以优化其围手术期疼痛管理。
最近的研究表明, 在外科手术中, 疼痛阈值的异常变化可能对乳腺癌手术的长期持续疼痛的发展有预测价值8。其他人强调了条件性疼痛调制 (CPM) 效应在预测持续性术后疼痛方面的重要性, 例如, 在开胸手术后的持续疼痛5。CPM 是弥漫性有害抑制控制的行为关联, 一种生理现象, 来自外周 c 纤维的输入导致来自异位场的 c 纤维介导的所有传入刺激的脑干的弥漫性抑制9.CPM 效应是通过将阈值与有害刺激进行比较来衡量的, 这是在第二种不同刺激的应用前后测量的, 这被称为条件反射刺激10。
目前标准化的定量感官测试 (QST) 协议, 如德国研究网络神经病理性疼痛协议11是相当广泛, 可能不适合在外科病人的执行。本出版物的目的是详述一个简短和标准化的协议, 以获得疼痛阈值和 CPM 效果测量乳腺癌手术患者。本协议来自于我们大学与丹麦奥尔堡大学的合作协议12。
Protocol
Representative Results
Discussion
我们的方法, 量化压力疼痛阈值, 电子疼痛阈值, 和 CPM 可以成功地应用在临床的情况下, 因为它的短时间 (约20分钟)。我们先前已经表明, 术后早期获得的压力疼痛值可能对预测乳腺癌手术中长期随访的持续疼痛有价值8。在我们的研究中, 虽然电子疼痛阈值 CPM 并不能预测持续性疼痛, 但其他的则表明这些措施对于其他程序513可能有价值?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
我们感谢参加 “代表性成果” 部分的研究的病人。
Materials
| Bed | N/A | N/A | Any type of hospital bed or medical exam table |
| Desk | N/A | N/A | Any type of commercially available desk |
| Office chair | N/A | N/A | Any type of commercially available office chair |
| Force FPX 50 Pressure algometer | Wagner Instruments, Greenwich, CT, USA | N/A | Pressure algometer with a 1.0 cm2 circular tip to deliver pressure to perform pressure pain threshold measurements |
| Desktop computer | N/A | N/A | Any type of commercially available Windows computer to run QST-IV Stimulus Manager software on to control the QST-IV stimulator |
| QST-IV Stimulus Manager | Embedded Control BV, Ruurlo, the Netherlands | N/A | Software to control the settings of QST-IV electrical stimulator |
| QST-IV Electrical Stimulator | Embedded Control BV, Ruurlo, the Netherlands | N/A | Electrical quantitative sensory testing device with a patient operated switch. Device used to deliver electrical current to perform the electrical threshold measurements |
| VAS Slider | Embedded Control BV, Ruurlo, the Netherlands | N/A | The VAS slider consists of a box with a mobile lever on a horizontal bar that represents the VAS and is connected to the QST-IV. |
| Kendall H34SG 50 x 45 mm | Covidien, Mansfield, USA | N/A | Self-adhesive skin electrodes to apply to the measurement points on the skin to deliver electrical stimualtion |
| Crushed Ice | N/A | N/A | Ice generated by ice machine to cool water sufficiently for the cold pressor test |
| Bucket | N/A | N/A | Any type of commercially available 10 L bucket |
| Surgical skin marker | Covidien, Mansfield, USA | N/A | Any type of commercially available surgical skin marker |
| Stopwatch | N/A | N/A | Any type of commercially available stopwatch |
| Measurement form | N/A | N/A | Score form provided in the manuscript |
| Pencil | N/A | N/A | Any type of commercially available pencil |
| Thermometer | N/A | N/A | Thermometer to measure water temperature of ice water |
| Ruler | N/A | N/A | Any type of commercially available ruler |
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