Disaggregating pain and its effect on physical functional limitations.
Disaggregating pain and its effect on physical functional limitations.
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分解疼痛及其对身体功能限制的影响。
DOI：
10.1093/gerona/53a.5.m361
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Hazuda,HP
中科院分区：
文献类型：
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作者：
Lichtenstein,MJ;Dhanda,R;Cornell,JE;Escalante,A;Hazuda,HP
背景.疼痛是一种常见的损害，限制老年人的能力。本文的目的是：(I)使用麦吉尔疼痛地图(McGill Pain Map，MPM)在以社区为基础的老年队列中描述疼痛位置的分布；(Ii)调查单个疼痛区域是否可以合理地划分为疼痛区域；(Iii)确定疼痛的强度、频率和位置是否构成疼痛的独立维度；以及(Iv)确定这三个疼痛维度是否对自我报告的身体功能受限的存在做出了不同的贡献。方法：研究方法。共有833名墨西哥裔美国人和欧洲裔美国人，年龄在65-79岁之间，参加了圣安东尼奥老龄化纵向研究，并在1992至1996年间在他们的家中接受了采访。共有373名受试者(46%)报告在过去一周内感到疼痛。使用Nagi量表的9个条目来确定身体功能限制。建立了三个复合量表：上肢、下肢和总分。使用McGill疼痛问卷确定疼痛强度和频率。通过MPM确定疼痛的位置。结果MPM的每个区域都有疼痛的报道。采用多组验证性因素分析，将36个部位分为7个痛区：头部、手臂、手腕、躯干、背部、大腿和小腿。在有疼痛的人中，疼痛的频率、强度和位置之间的相关性很弱。疼痛区域基本上是相互独立的，但在21个区域之间的成对关联中，有6个区域之间存在弱关联。疼痛区域与个体身体功能限制有不同的关联。9项体力任务中有8项与大腿疼痛有关。在多变量分析中，年龄、性别和种族仅占身体功能受限的2-3%。疼痛强度可解释功能受限综合评分的5~6%的变异量。疼痛频率解释了上肢受限的4-5%的变异，但对建立下肢受限的模型没有贡献。结论：我们测试了一种确定疼痛位置的方法，清楚地表明疼痛位置是自我报告的身体功能限制的一个重要决定因素。MPM方法可用于以人群为基础的研究，或用于侧重于特定损伤并寻求控制疼痛频率和强度的临床样本。未来的研究可以将特定的疾病与常见的疼痛损害联系起来，并梳理出导致其他损害(例如，虚弱)、功能限制和残疾的途径。
Background.Pain is a common impairment that limits the abilities of older persons. The purposes of this article are to: (i) describe the distribution of pain location using the McGill Pain Map (MPM) in a community-based cohort of aged subjects; (ii) investigate whether individual areas of pain could be sensibly grouped into regions of pain; (iii) determine whether intensity, frequency, and location constitute independent dimensions of pain; and (iv) determine whether these three pain dimensions make differential contributions to the presence of self-reported physical functional limitations. Methods. A total of 833 Mexican American and European American subjects, aged 65–79 years, were enrolled in the San Antonio Longitudinal Study of Aging and were interviewed in their homes between 1992 and 1996. A total of 373 (46%) of the subjects reported having pain in the past week. Physical functional limitations were ascertained using the nine items from the Nagi scale. Three composite scales were created: upper extremity, lower extremity, and total. Pain intensity and frequency were ascertained using the McGill Pain Questionnaire. Pain location was ascertained by using the MPM.Results.Pain was reported in every area of the MPM. Using multiple groups confirmatory factor analysis, the 36 areas were grouped into 7 regions of pain: head, arms, hands and wrists, trunk, back, upper leg, and lower leg. Among persons with pain, pain frequency, intensity, and location were weakly associated with each other. Pain regions were primarily independent of each other, yet weak associations existed between 6 of the 21 pair-wise correlations between regions. Pain regions were differentially associated with individual physical functional limitations. Pain in the upper leg was associated with 8 of the 9 physical tasks. In multivariate analyses, age, gender, and ethnic group accounted for only 2–3% of the variance in physical functional limitations. Pain intensity accounted for 5–6% of the variance in the composite scores of functional limitation. Pain frequency accounted for 4–5% of the variance in upper extremity limitations but did not contribute to the modeling of lower extremity limitations. In contrast, pain location accounted for 9–14% of the variance in physical functional limitations.Conclusions.We tested a method for ascertaining pain location and clearly demonstrated that pain location is an important determinant of self-reported physical functional limitations. The MPM methodology may be used in population- based studies or in clinical samples that focus on specific impairments and seek to control for pain frequency and intensity. Future studies can link specific diseases with the common impairment of pain and tease out the pathways that lead to other impairments (e.g., weakness), functional limitations, and disability.