Symptoms of distress as prospective predictors of pain-related sciatica treatment outcomes
Symptoms of distress as prospective predictors of pain-related sciatica treatment outcomes
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DOI：
10.1016/j.pain.2006.10.026
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发表时间：
2007-07-01
期刊：
影响因子：
7.4
通讯作者：
Atlas, Steven J.
中科院分区：
文献类型：
--
作者：
Edwards, Robert R.;Klick, Brendan;Atlas, Steven J.
先前评估坐骨神经痛治疗后疼痛相关结局预测因素的研究受到方法学问题的限制，包括回顾性研究设计、使用未经验证的结局指标和短期随访。尽管存在这些局限性，但一些报告表明，心理困扰的症状可能预测疼痛治疗相关结局的个体差异（例如，治疗后抑郁和焦虑程度越高，疼痛和残疾程度越大）。在这项研究中，我们试图确定是否抑郁和焦虑的急性症状与手术治疗和非手术治疗的坐骨神经痛患者在3年的随访期内的治疗结果有前瞻性相关。患者从缅因州的社区医生的实践中招募，并进行了亲自基线评估，并在3，6，12，24和36个月时邮寄随访问卷。研究结果包括患者报告的疼痛和残疾症状。对于每个结果变量，我们检查了基线情绪（即，在多变量重复测量分析中，在治疗开始前评估的情绪），以及在紧接的前一评估点的情绪，前瞻性地预测了3年的结果。在大多数分析中，在控制相关协变量后，基线和之前时间点的抑郁和焦虑症状是疼痛和功能恶化的显著独立预测因子。总的来说，痛苦的增加似乎是降低治疗获益的一个重要风险因素（即，疼痛和残疾改善较少）。未来的研究应该确定是否前瞻性识别和治疗患者的高水平的痛苦（“黄旗”）与改善治疗结果。(C)2006年国际疼痛研究协会。Elsevier B.V.出版，保留所有权利。
Prior studies evaluating predictors of pain-related outcomes following treatment for sciatica have been limited by methodological problems, including retrospective study design, use of unvalidated outcome measures, and short-term follow-up periods. Despite these limitations, some reports have suggested that symptoms of psychological distress may predict individual differences in pain treatment-related outcomes (e.g., higher levels of depressive and anxious symptomatology are associated with greater pain and disability after treatment). In this study, we sought to determine whether acute symptoms of depression and anxiety were prospectively associated with treatment outcomes over a 3-year follow-up period in surgically treated and non-surgically treated patients with sciatica. Patients were recruited from the practices of community-based physicians throughout the state of Maine, and underwent in-person baseline assessments, with mailed follow-up questionnaires at 3, 6, 12, 24, and 36 months. Study outcomes included patient-reported symptoms of pain and disability. For each outcome variable, we examined whether baseline mood (i.e., mood assessed prior to the initiation of treatment), as well as mood at the immediately preceding assessment point, prospectively predicted outcomes over 3 years in multivariate repeated-measures analyses. Tn most analyses, symptoms of depression and anxiety, both at baseline and at the preceding time point, were significant independent predictors of worse pain and function after controlling for relevant covariates. Collectively, elevated distress appears to be a significant risk factor for reduced treatment benefit (i.e., less improvement in pain and disability) over short and medium-term follow-up periods in patients with sciatica. Future research should determine whether the prospective identification and treatment of patients with high levels of distress (a "yellow flag") is associated with improved treatment outcomes. (C) 2006 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.