Impact of neck and arm pain on overall health status
Impact of neck and arm pain on overall health status
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DOI：
10.1097/01.brs.0000083325.27357.39
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发表时间：
2003-09-01
期刊：
影响因子：
3
通讯作者：
Albert, TJ
中科院分区：
文献类型：
--
作者：
Daffner, SD;Hilibrand, AS;Albert, TJ
研究设计.对国家脊柱网络数据库数据的前瞻性、多中心、横断面分析。通过SF-36健康调查，比较与颈椎疾病相关的神经根性和轴性症状对一般健康状况的相对影响，并比较这些症状在不同年龄和症状持续时间的患者中的影响。颈椎退行性疾病可导致颈部和手臂疼痛的衰弱症状。医生通常治疗神经根病更积极比轴性颈痛单独，虽然它从来没有被证明，神经根病的存在会导致更大的损害的身体和精神功能。SF-36健康调查数据收集自国家脊柱网络中所有知情同意的患者。纳入了症状与颈椎相似的患者（根据他们的医生）（n = 1，809）。计算所有8个量表（身体疼痛（BP）、活力（VT）、一般健康状况（GH）、心理健康状况（MH）、身体功能（PF）、身体角色（RP）、情感角色（RE）和社会功能（SF））的SF-36评分，以及2个汇总量表（身体成分汇总[PCS]和心理成分汇总[MCS]）。从量表评分中减去年龄/性别标准评分，以产生负面“影响”评分，反映这些患者的健康状况低于正常健康状况的程度。根据症状部位（仅轴向、仅神经根或轴向和神经根）、年龄（小于40岁、40 - 60岁和大于60岁）和症状持续时间（急性：6个月）对患者进行分组。采用方差分析和Bonferroni校正的多重比较方法比较各组间SF-36评分。与年龄和性别标准相比，同时出现轴性和神经根性症状的患者的SF-36评分最低。在所有8个分量表中，这些评分均显著低于仅轴性或仅神经根性症状的患者（P < 0.05-P < 0.0001）。仅轴性疼痛患者VT（P < 0.04）和GH（P < 0.004）评分显著低于仅根性疼痛患者。年龄小于40岁和40 ~ 60岁的患者比60岁以上的患者在所有8个量表上受症状的影响更大（P < 0.01）。急性、亚急性和慢性组的PCS评分相似，而慢性疼痛患者的MCS评分明显较差。结论。颈部和手臂疼痛的组合比单独的症状更能致残。年轻患者（40岁以下或40-60岁）比60岁以上的患者更容易受到这些症状的影响。此外，随着症状持续时间的增加，观察到对心理健康的负面影响，尽管慢性症状不影响身体健康。这项研究表明，患者的一个重要组成部分的轴性疼痛与颈椎神经根病应被认为是最受影响的所有患者的颈椎病。鉴于有证据表明医生使用的治疗方法是有效的，这项研究表明，对这些患者的及时治疗可能有助于避免慢性症状对心理功能的有害影响，特别是在发现受症状影响更大的年轻患者中。
Study Design. A prospective, multicenter, cross-sectional analysis of data from the National Spine Network database.Objectives. To compare the relative impact of radicular and axial symptoms associated with disease of the cervical spine on general health as measured by the SF-36 Health Survey, and to compare the impact of these symptoms among patients of varying age and symptom duration.Background. Degenerative disorders of the cervical spine can cause debilitating symptoms of neck and arm pain. Physicians generally treat radiculopathy more aggressively than axial neck pain alone, although it has never been shown that the presence of radiculopathy leads to a greater impairment of physical and mental function.Materials and Methods. SF-36 Health Survey data were collected from all consenting patients seen within the National Spine Network. Patients with symptoms referable to the cervical spine (as per their physician) were included (n = 1,809). SF-36 scores for all eight scales (bodily pain (BP), vitality (VT), general health (GH), mental health (MH), physical function (PF), role physical (RP), role emotional (RE), and social function (SF), and two summary scales (Physical Component Summary [PCS] and Mental Component Summary [MCS]) were calculated. Age/gender normative scores were subtracted from the scale scores to produce a negative "impact" score, which reflected how far below normal health status these patients were. Patients were grouped according to location of symptoms (axial only, radicular only, or axial and radicular), age (younger than 40, 40 to 60, and older than 60 years), and symptom duration (acute: 6 mo). SF-36 scores were compared between all groups using analysis of variance and multiple comparisons with Bonferroni adjustment.Results. Patients who presented with both axial and radicular symptoms had the lowest SF-36 scores relative to age and gender norms. These scores were significantly lower than those for patients with only axial or only radicular symptoms across all eight subscales (P < 0.05-P < 0.0001). Scores for patients with only axial pain were significantly lower than for patients with only radicular pain for VT (P < 0.04) and GH (P < 0.004). Patients younger than 40 and those between ages 40 to 60 years were significantly more impacted by their symptoms than patients older than 60 years for all eight scales (P < 0.01). PCS scores were similar for acute, subacute, and chronic groups, whereas MCS scores were significantly worse for patients with chronic pain.Conclusions. Combined neck and arm pain were much more disabling than either symptom alone. Younger patients (younger than 40 or 40-60) were more affected by these symptoms than patients older than 60 years. In addition, as symptom duration increased, a negative impact on mental health was observed, although chronic symptoms did not affect physical health. This study suggests that patients with a significant component of axial pain in conjunction with cervical radiculopathy should be considered the most affected of all patients with cervical spondylosis. Given the evidence that the treatment methods at the disposal of physicians are effective, this study suggests that prompt treatment of these patients may help avoid the harmful effects of chronic symptoms on mental functioning, especially among younger patients who were found to be more impacted by the symptoms.