A Longitudinal Study on the Pain Trajectories and Affected Factors in Patients With Pulmonary Nodules Following Video-Assisted Thoracoscopic Surgery

Abstract

Purpose: This study aimed to investigate the types of pain trajectories after video-assisted thoracoscopic surgery in patients with pulmonary nodules, and to explore the influencing factors of different pain trajectories, to provide potential intervention targets and practical basis for clinical precision pain management.

Methods: 202 patients with pulmonary nodules who underwent thoracoscopic surgery were selected as the study subjects. The baseline data of patients was collected using the general data questionnaire, Pain Sensitivity Questionnaire, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Brief Fatigue Inventory, and Pain Catastrophic Scale. Numerical rating scale was used to assess patients' pain level at 7 time points from 1 to 3 days, 1 week, month 1, 3, and 6. The growth mixture model (GMM) was applied to identify pain trajectory categories, and multinomial logistic regression analysis was conducted to investigate the influencing factors of post-thoracoscopic pain trajectories.

Results: Three types of pain trajectories were identified: moderate pain rapid decline group (68.3%), moderate pain initial increase followed by rapid decline group (23.9%), and severe pain slow decline group (7.7%). Multinomial logistic regression results show that history of chronic pain, pain sensitivity, postoperative PCIA dosage, acute postoperative pain, and preoperative fatigue are independent predictors of the unfavourable pain trajectory after thoracoscopic surgery (p < 0.05).

Conclusion: There is population heterogeneity in post-thoracoscopic pain in patients with pulmonary nodules and it may be closely related to a variety of preoperative and postoperative somatic sensations. Based on this, medical staff need to develop targeted interventions for patients to improve their postoperative pain.

Significance statement: This study identifies the group heterogeneity of pain trajectories after video-assisted thoracoscopic surgery in patients with pulmonary nodules and provides longitudinal follow-up data at more time points and over a longer time span. Also, we analyse in detail their possible influencing factors of pain trajectories from a variety of perspectives to provide potential intervention targets and practice basis for precise clinical pain management, which can positively contribute to the improvement of patients' postoperative quality of life.