Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain.
Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain.
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DOI：
10.1038/s41393-021-00731-4
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发表时间：
2022-03
期刊：
影响因子：
2.2
通讯作者：
Mahmoudi E
中科院分区：
文献类型：
--
作者：
Peterson MD;Meade MA;Lin P;Kamdar N;Rodriguez G;Krause JS;Mahmoudi E
有和没有创伤性脊髓损伤（SCI）的私人保险受益人的纵向队列研究。比较创伤性脊髓损伤和非创伤性脊髓损伤成人心理疾病的发生率和调整后的危险因素，并检查慢性集中性疼痛和神经性疼痛对结果的影响。如果有ICD-9-CM创伤性脊髓损伤诊断代码（n= 9081），则纳入私人保险受益人。无脊髓损伤的成年人也被纳入（n=1,474,232）。在入组5年时比较常见心理疾病的发生率。生存模型用于量化未调整和调整的意外心理发病率的风险比。与没有脊髓损伤的成年人相比，脊髓损伤的成年人有更高的心理发病率（59.1%比30.9%），差异具有临床意义。生存模型表明，脊髓损伤成人有更大的心理疾病风险（HR: 1.67; 95%CI: 1.61, 1.74），以及除一种心理障碍（冲动控制障碍）外的所有心理障碍风险（HR: 1.31(1.24, 1.39)），从失眠的HR: 1.31（1.24, 1.39）到创伤后应激障碍的HR: 2.10（1.77, 2.49）。集中和神经性疼痛与所有心理障碍相关，痴呆的HR为1.31(1.23,1.39)，焦虑的HR为3.83（3.10,3.68）。与没有脊髓损伤的成年人相比，脊髓损伤的成年人有更高的常见心理疾病的发病率和风险。需要努力促进早期干预措施的发展，以降低这一高危人群中慢性集中性和神经性疼痛以及心理发病率的发生/进展的风险。
Longitudinal cohort study of privately-insured beneficiaries with and without traumatic spinal cord injury (SCI). Compare the incidence of and adjusted hazards for psychological morbidities among adults with and without traumatic SCI, and examine the effect of chronic centralized and neuropathic pain on outcomes. Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for traumatic SCI (n=9,081). Adults without SCI were also included (n=1,474,232). Incidence of common psychological morbidities were compared at 5-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. Adults with SCI had a higher incidence of any psychological morbidity (59.1% vs. 30.9%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater hazard for any psychological morbidity (HR: 1.67; 95%CI: 1.61, 1.74), and all but one psychological disorder (impulse control disorders), and ranged from HR: 1.31 (1.24, 1.39) for insomnia to HR: 2.10 (1.77, 2.49) for post-traumatic stress disorder. Centralized and neuropathic pain was associated with all psychological disorders, and ranged from HR: 1.31 (1.23, 1.39) for dementia to HR: 3.83 (3.10, 3.68) for anxiety. Adults with SCI have a higher incidence of and risk for common psychological morbidities, as compared to adults without SCI. Efforts are needed to facilitate the development of early interventions to reduce risk of chronic centralized and neuropathic pain and psychological morbidity onset/progression in this higher risk population.
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