Does chronic pain predict future psychological distress?
Does chronic pain predict future psychological distress?
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DOI：
10.1016/s0304-3959(01)00452-3
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发表时间：
2002-04-01
期刊：
影响因子：
7.4
通讯作者：
Silman, AJ
中科院分区：
文献类型：
--
作者：
McBeth, J;Macfarlane, GJ;Silman, AJ
横断面研究一直表明慢性广泛性疼痛，纤维肌痛的临床标志和心理困扰之间的关系。这些研究无法区分任何因果关系的方向。最近基于人群的研究报告说，这种疼痛是未来痛苦的预测。然而，慢性疼痛往往与身体和心理共病的功能，可能混淆这种关系。本研究的目的是检验这一假设，即在调整了可能的混杂因素后，慢性广泛性疼痛会增加未来痛苦的风险。对1953人进行的一项基于人群的调查确定了受试者的心理状态以及他们是否符合慢性广泛性疼痛的标准。在基线时，测量了慢性广泛疼痛的共病特征，包括报告其他躯体症状、异常疾病行为、健康焦虑、疲劳和低水平的自我护理。所有受试者在12个月后进行随访，以确定心理困扰的程度。基线时有慢性广泛性疼痛的受试者在随访时更可能感到痛苦（OR = 4.0，95%CI（2.5，6.3））。由于随访时的痛苦水平可能只是反映了基线时的痛苦水平，因此对基线痛苦水平进行了调整。然而，慢性广泛性疼痛仍然与未来的痛苦有关，尽管这种关系略有减弱（比值比，OR = 3.0，95%CI（1.8，5.1））。为了检验我们的主要假设，进行了最终分析，调整了基线时评估的合并症特征的相关性。在这些调整之后，慢性广泛性疼痛不再与未来的痛苦显著相关（OR = 1.5，95%CI（0.8，2.9））。慢性广泛性疼痛与随访时心理困扰水平的增加有关。然而，一项更严格的分析表明，基线疼痛状态与未来痛苦之间的关联是由慢性疼痛的伴随特征而不是疼痛本身来解释的。这些研究结果表明，正是那些患有慢性广泛性疼痛的人，在其他身体和心理社会因素的存在下，才会变得痛苦。(C)2002年国际疼痛研究协会。由Elsevier Science B.V.出版，版权所有。
Cross-sectional studies have consistently shown a relationship between chronic widespread pain, the clinical hallmark of fibromyalgia, and psychological distress. These studies cannot distinguish the direction of any causal relationship. Recent population based studies have reported that such pain is predictive of future distress. However, chronic pain is often associated with physical and psychological co-morbid features which may confound this relationship. The aim of this study was to examine the hypothesis that chronic widespread pain increases the risk of future distress after adjusting for the effects of possible confounding factors. A population based survey of 1953 individuals identified subjects' psychological status and whether they satisfied criteria for chronic widespread pain. At baseline co-morbid features of chronic widespread pain, including reporting other somatic symptoms, abnormal illness behaviour, health anxiety, fatigue and low levels of self-care, were measured. All subjects were followed up after 12 months to determine levels of psychological distress. Subjects with chronic widespread pain at baseline were much more likely to be distressed at follow up (OR = 4.0, 95% CI (2.5,6.3)). As levels of distress at follow up may simply reflect those at baseline the association was adjusted for baseline levels of distress. Chronic widespread pain was, however, still associated with future distress although the relationship was slightly attenuated (odds ratio, OR = 3.0, 95% CI (1.8,5.1)). To examine our main hypothesis a Final analysis was undertaken adjusting this association for those co-morbid features assessed at baseline. Following these adjustments chronic widespread pain was no longer significantly associated with future distress (OR = 1.5, 95% CI (0.8,2.9)). Chronic widespread pain was associated with increased levels of psychological distress at follow up. However, a more rigorous analysis indicated that the association between baseline pain status with future distress was explained by concomitant features of chronic pain rather than pain per se. These findings indicate that it is those persons with chronic widespread pain in the presence of other physical and psychosocial factors who will become distressed. (C) 2002 International Association for the study of Pain. Published by Elsevier Science B.V. All rights reserved.