标题: Primary Prevention of Chronic Pain [打印本页] 作者: libingccmb 时间: 2020-8-12 01:56 标题: Primary Prevention of Chronic Pain
疼痛的一级预防Primary Prevention of Chronic Pain
Introduction
Primary prevention of pain is defined as preventing acute pain, secondary prevention addresses thetransition from acute to chronic pain and tertiary prevention aims to reduce the impact of chronic pain[5]. In the following, the evidence for primary prevention interventions for post-surgical pain andworkplace injuries is summarized.
Primary Prevention of Pain in Research
Chronic post-surgical pain Surgical procedures are common, often cause acute pain, affect a largeproportion of the population and are probably the most researched pain condition in relation to primaryprevention [1]. Preventive measures include pre-habilitation, pre- and perioperative pharmacotherapyand anaesthesia as well as post-discharge interventions. Pre-habilitation, consisting mainly of aerobicand resistance exercise may improve physical function, length of stay and pain following surgerycompared with standard care (low quality of evidence) [8]. Patient education is assumed to reduce fearor anxiety of pain from surgical procedures, however, current low-quality evidence suggests thatpreoperative education alone may not improve post-operative pain, function and health-related qualityof life or postoperative anxiety any more than usual care [6]. However, preoperative psychologicalinterventions including information, cognitive interventions or relaxation strategies may have small, butsignificant positive effects on postoperative pain, length of stay, or negative affect (very low to lowquality of evidence) [7].
The efficacy of pharmacotherapy and anaesthesia for preventing chronic pain after surgery wasinvestigated and is discussed in detail in another fact sheet (see “Prevention of Chronic Post-SurgicalPain” Fact Sheet).
Investigation of post-discharge interventions to reduce severity of chronic pain after total kneearthroplasty, consisting mainly of physiotherapy, suggests that these interventions appear to beeffective [15]
As indicated by recent flagship projects (but without an RCT supporting this so far) an interdisciplinaryapproach that includes pre-surgical, in-hospital post-surgical and out-of-hospital post-dischargeinterventions performed by a multi-professional “transitional pain service” seems promising to preventchronic pain after surgery in patients at risk [4, 13]. As a prerequisite, prediction tools to identifypatients at high risk for developing chronic pain after surgery are needed and many research groups areworking on this [9]
Occupational interventions aim to reduce work-related incidents and injuries leading to acute pain.Interventions should address modifiable physical and psychological risk factors that increase significantlythe odds of a new onset of back pain. These include exposure to manual tasks involving awkwardpositioning (OR 8.0, 95% CI 5.5–11.8) or being distracted during a task or activity (OR 25.0, 95% CI 3.4–184.5) or being fatigued (OR 3.7, 95% CI 2.2–6.3) [11]. However, there is moderate quality evidence thatmanual material handling advice and training with or without assistive devices does not prevent backpain or back pain‐related disability when compared to no intervention or alternative interventions [14].Common occupational interventions include exercise alone (RR 0.65, 95%KI 0.50-0.86) or in combinationwith education (RR 0.55, 95% KI 0.41-0.74) that both reduce the risk of developing LBP in the first place(low to moderate quality of evidence) [12], findings supported by a recent overview of reviews [10].
Other occupational interventions such as education alone (booklets, back schools, videos), foot orthosesor shoe insoles or lumbar support (back belts, braces, chair back rests) had no effect on the incidence ofLBP [10].Physical ergonomic interventions include improving equipment and environment of the workplace toreduce the physical strain to the musculoskeletal system [3].
One meta-analysis found inconclusive lowto moderate quality evidence for arm support with an alternative computer mouse in reducing theincidence of neck or shoulder or right upper limb musculoskeletal disorders, and very low-qualityevidence that supplementary breaks reduce discomfort of the neck (MD −0.25; 95% CI −0.40 to −0.11),right shoulder or upper arm (MD −0.33; 95% CI −0.46 to −0.19), and right forearm or wrist or hand (MD -0.18; 95% CI -0.29 to -0.08) among office workers [3]. No effect on upper limb pain or discomfort wasfound for workstation adjustment and sit-stand desks [3]
ConclusionFew studies explicitly address the efficacy and efficiency of primary prevention interventions for chronicpain highlighting the need for high quality research in this area. One future approach to primaryprevention of chronic pain may be public health interventions aimed at both the general population andhigh-risk groups [5]. Public education may heighten awareness about pain and its health consequences,improve public knowledge about strategies that individuals can use to manage their own pain, andaddress disparities that exist in the experience of pain [2].
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