Año 2023 / Volumen 30 / Número 4

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Artículo de la revista EJP

Trayectorias del dolor y síntomas de dolor neuropático tras la cirugía de cáncer de pulmón: estudio de cohorte prospectivo
Pain trajectories and neuropathic pain symptoms following lung cancer surgery: a prospective cohort study

Rev. Soc. Esp. Dolor. 2023; 30(4): 270-283 / 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


RESUMEN

Antecedentes: El dolor postquirúrgico persistente (PPSP) tras la cirugía del cáncer de pulmón es frecuente y las definiciones actuales se basan en evaluaciones en un único momento tras la cirugía. Sin embargo, la intensidad del dolor y los síntomas pueden fluctuar y cambiar con el tiempo, y verse afectados por factores múltiples y cambiantes. Se necesitan estudios de los patrones de recuperación postoperatoria y de la transición del dolor agudo al crónico para seguir investigando medidas preventivas y tratamientos que modifiquen las trayectorias de recuperación desfavorables.
Métodos: En este estudio exploratorio, 85 pacientes sometidos a cirugía por cáncer de pulmón presunto o confirmado informaron bimensualmente sobre la intensidad del dolor durante 12 meses. Se investigaron las trayectorias del dolor durante la recuperación, utilizando modelos de trayectorias basados en grupos. También se estudiaron las asociaciones con posibles factores de riesgo de PPSP, incluidas variables clínicas y la puntuación de ansiedad y depresión (HADS).
Resultados: Se calculó un modelo de trayectoria que contenía tres grupos de recuperación del dolor a los 12 meses. Un grupo sin PPSP se recuperó totalmente (50 %) en un plazo de dos a tres meses. Otro grupo con PPSP de intensidad leve siguió una trayectoria de recuperación prolongada (37 %), mientras que en el último grupo se observó una recuperación incompleta (13 %). El dolor postoperatorio agudo y la menor edad se asociaron a una trayectoria de recuperación menos favorable. Se observaron más síntomas de dolor neuropático en los pacientes con recuperación incompleta.
Conclusiones: Se identificaron tres trayectorias de recuperación clínicamente relevantes, basadas en un seguimiento exhaustivo del dolor. La mayor intensidad del dolor postoperatorio agudo se asoció a una trayectoria de recuperación del dolor desfavorable.
Declaración de importancia: Comprender la transición del dolor postoperatorio agudo al crónico e identificar los factores de riesgo preoperatorios es esencial para el desarrollo de tratamientos específicos y la aplicación de medidas preventivas. Este estudio: 1) identificó distintas trayectorias de recuperación basadas en seguimientos frecuentes de evaluación del dolor durante 12 meses después de la cirugía; y 2) evaluó los factores de riesgo de trayectorias de recuperación del dolor postoperatorio desfavorables. Los resultados sugieren que una mayor intensidad del dolor postoperatorio al inicio se asocia con una trayectoria de recuperación desfavorable a largo plazo.



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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Danielsen A, Andreasen J, Dinesen B, Hansen J, Petersen K, Duch K, et all. Trayectorias del dolor y síntomas de dolor neuropático tras la cirugía de cáncer de pulmón: estudio de cohorte prospectivo . Rev Soc Esp Dolor 2023; 30(4): 270-283 / DOI: 101002/ejp2265


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