Symptoms of depression and stress mediate the effect of pain on disability
Symptoms of depression and stress mediate the effect of pain on disability
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DOI：
10.1016/j.pain.2011.01.014
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发表时间：
2011-05-01
期刊：
影响因子：
7.4
通讯作者：
Nicholas, Michael K.
中科院分区：
文献类型：
--
作者：
Hall, Amanda M.;Kamper, Steven J.;Nicholas, Michael K.
下背痛患者疼痛相关残疾发展的机制尚不清楚。心理困扰已被确定为一个潜在的途径，疼痛发作影响持续性残疾症状的发展，但是，这种关系尚未得到正式调查。本研究采用中介路径分析法，通过心理困扰（包括抑郁、压力和焦虑）探讨疼痛与残疾之间的因果关系。研究样本包括231名患有亚急性腰痛（疼痛持续时间为6至12周）的参与者，他们被招募参加一项基于运动的随机对照试验。所有参与者在基线和2个随访时间点（基线后6周和12周）完成疼痛（0-10数字评定量表）、残疾（罗兰莫里斯残疾问卷）和心理困扰（抑郁焦虑和压力量表）的自我报告评估。中介分析的结果表明，大约30%的亚急性疼痛和后来的残疾之间的关系是依赖于患者的心理困扰的水平。研究发现，心理困扰只有部分（30%）介导的疼痛残疾的关系表明，其他因素也应该加以探讨。进一步分析心理困扰的组成部分发现，抑郁和压力的症状，而不是焦虑，负责调解的疼痛残疾的关系。这些发现提供了一个机会，通过早期识别和管理抑郁和压力症状，以减少长期残疾的风险。皇冠版权所有（C）2011由Elsevier B. V.代表国际疼痛研究协会出版。All rights reserved.
The mechanism or mechanisms involved in the development of pain-related disability in people with low back pain is unclear. Psychological distress has been identified as one potential pathway by which an episode of pain influences the development of persistent disabling symptoms; however, the relationship has not been formally investigated. This study investigated the causal relationship between pain and disability via psychological distress (and its components depression, stress, and anxiety) by using mediation path analysis. The study sample included 231 participants with subacute low back pain (6 to 12 weeks' pain duration) who had been recruited for an exercise-based randomised, controlled trial. All participants completed self-report assessments of pain (0-10 numerical rating scale), disability (Roland Morris Disability Questionnaire), and psychological distress (Depression Anxiety and Stress Scale) at baseline and again at 2 follow-up time points (6 and 12 weeks after baseline). The results of the mediation analysis suggest that approximately 30% of the relationship between subacute pain and later disability is dependent on the level of patients' psychological distress. The finding that psychological distress only partially (30%) mediated the pain-disability relationship indicates that other factors should also be explored. Further analysis into the components of psychological distress revealed that the symptoms of depression and stress, but not anxiety, are responsible for mediation of the pain-disability relationship. These findings provide an opportunity to decrease the risk of long-term disability through early identification and management of depressive and stress symptoms. Crown Copyright (C) 2011 Published by Elsevier B.V. on behalf of International Association for the Study of Pain. All rights reserved.