OBJECTIVE To investigate pain catastrophizing presentations up to 6-months postoperatively and subsequent changes in pain intensity and physical function. DESIGN Prospective observational multisite study SETTING: Two tertiary care facilities between 2016 and 2019 PARTICIPANTS: Adult patients undergoing a mastectomy, thoracic surgery, total knee or hip arthroplasty, spinal fusion, or major abdominal surgery. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Pain Catastrophizing Scale (PCS) scores, Defense and Veterans Pain Rating Scale (DVPRS) Average Pain Intensity, and Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function. RESULTS Four pain catastrophizing trajectories were identified in 348 surgical patients throughout the six months of postoperative recovery: stable, remitting, worsening, and unremitting. Linear mixed-effects models found that the unremitting trajectory was associated with higher pain intensity over time. The average pain intensity of participants in the remitting trajectory was estimated to decrease at a faster rate over 6-months following surgery than other trajectories' pain, despite participants reporting high preoperative PCS and pain scores. Worsening and unremitting trajectories were associated with reduced physical function. Preoperative average pain intensity scores were not associated with postoperative physical function scores, nor were participants' preoperative physical function scores associated with average pain intensity scores postoperatively. Prolonged hospitalization, smoking, and preoperative opioid prescriptions were associated with the unremitting trajectory. CONCLUSIONS Findings suggest that preoperative pain catastrophizing scores alone may not be adequate for estimating long-term patient-reported outcomes throughout postoperative rehabilitation. Pain catastrophizing has a dynamic presentation and is associated with changes in pain intensity and physical function up to 6-months postoperatively. Routine assessments can inform the delivery of early interventions to surgical patients at risk of experiencing a pain catastrophizing trajectory associated with suboptimal outcomes during rehabilitation.

中文翻译：

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6 个月内离散和动态的术后疼痛灾难性轨迹：一项前瞻性观察研究

目的 调查术后长达 6 个月的疼痛灾难性表现以及随后疼痛强度和身体功能的变化。设计 前瞻性观察性多中心研究 设置：2016 年至 2019 年间的两个三级医疗机构 参与者：接受乳房切除术、胸外科手术、全膝关节或髋关节置换术、脊柱融合术或腹部大手术的成年患者。干预 不适用。主要结果测量 (S) 疼痛灾难化量表 (PCS) 分数、国防和退伍军人疼痛评定量表 (DVPRS) 平均疼痛强度，以及患者报告的结果测量信息系统 (PROMIS) 身体功能。结果 在术后恢复的整个六个月内，348 名手术患者确定了四种疼痛灾难性轨迹：稳定、缓解、恶化和持续。线性混合效应模型发现，随着时间的推移，坚持不懈的轨迹与更高的疼痛强度相关。尽管参与者报告术前 PCS 和疼痛评分较高，但据估计，与其他轨迹的疼痛相比，缓解轨迹参与者的平均疼痛强度在术后 6 个月内以更快的速度下降。恶化和持续的轨迹与身体机能下降有关。术前平均疼痛强度评分与术后身体功能评分无关，参与者的术前身体功能评分与术后平均疼痛强度评分无关。长期住院、吸烟和术前阿片类药物处方与坚持不懈的轨迹有关。结论 研究结果表明，单独的术前疼痛灾难性评分可能不足以估计整个术后康复过程中患者报告的长期结果。疼痛灾难化具有动态表现，并且与术后 6 个月内疼痛强度和身体功能的变化有关。常规评估可以为有可能经历与康复期间次优结果相关的疼痛灾难性轨迹的手术患者提供早期干预措施的信息。