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Article

Прогностические модели выраженности острой динамической боли в первые сутки после операции и вероятности возникновения хронической послеоперационной боли в хирургии позвоночника

Генов П., Тимербаев В., Долгашева Н., Ефанов А., Гринь А., Реброва О. Ю.

The risk factors for acute pain as well as chronic pain syndrome (CPS) in spine surgery have not been defined to date. Purpose — to define the prognostic parameters of acute pain severity and the risk of CPS in patients operated on for spinal diseases and injuries. Material and methods. The study included 291 patients operated on for degenerative diseases and injuries of the spine at the Sklifosovsky Research Institute of Emergency Medicine in 2010―2016. Sociodemographic and clinical data and the psychological status of patients were evaluated. A mechanical algometer was used to measure the pain threshold (PT) and pain tolerance. The movement pain intensity was assessed by using a visual analog scale (VAS) on the day of surgery. Pain was considered minor at a median score of 0―4 cm and severe at a median score of 5―10 cm. The presence of CPS was assessed during a telephone survey 5―7 months after surgery. Results. The gender, PT, dynamic pain intensity before surgery, and expectation of postoperative pain are risk factors for severe acute postoperative pain. A multinomial logit regression model (Hosmer—Lemeshow test ― 4.322; p=0.827) predicts minor dynamic pain on the 1postoperative day with an accuracy of 70% (95% CI 63—76). The age and dynamic pain intensity on the 1postoperative are the risk factors for CPS; the multinomial logit regression model (Hosmer—Lemeshow test ― 3.1; p=0.928) predicts CPS with an accuracy of 65% (95% CI 59—71) 5―7 months after surgery. Conclusion. The developed software in the form of MS Excel calculators provides a particular patient with preoperative assessment of the risk for minor acute dynamic pain on the 1postoperative day and CPS 5―7 months after surgery.