The influence of multisite pain and psychological comorbidity on prognosis of chronic low back pain: longitudinal data from the Norwegian HUNT Study.
The influence of multisite pain and psychological comorbidity on prognosis of chronic low back pain: longitudinal data from the Norwegian HUNT Study.
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DOI：
10.1136/bmjopen-2016-015312
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发表时间：
2017-06-06
期刊：
影响因子：
2.9
通讯作者：
Mork PJ
中科院分区：
文献类型：
--
作者：
Nordstoga AL;Nilsen TIL;Vasseljen O;Unsgaard-Tøndel M;Mork PJ
本研究旨在探讨多部位疼痛、抑郁、焦虑、自评健康和疼痛相关残疾对慢性下腰痛(LBP)康复的预期影响。数据来源于挪威诺德-特伦德拉格健康研究(Hunt)的第二波(1995-1997年)和第三波(2006-2008年)。研究人群包括挪威猎人研究中的4484名女性和3039名男性，他们报告在1995-1997年期间患有慢性LBP。主要结果是在11年的随访中从慢性LBP中恢复。在过去一年中连续三个月没有报告疼痛和/或僵硬的人被定义为痊愈。用泊松回归模型估计95%CI的调整风险比(RR)。在随访中，1822名女性(40.6%)和1578名男性(51.9%)报告从慢性LBP中恢复。痊愈的概率与疼痛部位的数量呈负相关(P-Trend<；0.001)。与报告2-3个痛点相比，只有2-3个痛点的患者恢复的概率略高(女性RR 1.10，95% CI 0.98~1.22，男性RR 1.10，95% CI 1.01~1.21)，而报告6~9个痛点的患者康复概率显著降低(女性RR 0.58，95% CI 0.52~0.63，男性RR 0.70，95% CI 0.63~0.79)。自评总体健康状况差/不太好，焦虑和抑郁症状，以及工作和休闲中与疼痛相关的残疾都与康复概率降低有关，但多部位疼痛与这些并存之间没有统计上的交互作用。疼痛部位数量的增加与慢性LBP的恢复成反比。此外，自我健康状况不佳、心理症状和疼痛相关残疾等因素可能会进一步降低慢性LBP康复的可能性。
This study aimed to investigate the prospective influence of multisite pain, depression, anxiety, self-rated health and pain-related disability on recovery from chronic low back pain (LBP). The data is derived from the second (1995–1997) and third (2006–2008) wave of the Nord-Trøndelag Health Study (HUNT) in Norway. The study population comprises 4484 women and 3039 men in the Norwegian HUNT Study who reported chronic LBP at baseline in 1995–1997. The primary outcome was recovery from chronic LBP at the 11-year follow-up. Persons not reporting pain and/or stiffness for at least three consecutive months during the last year were defined as recovered. A Poisson regression model was used to estimate adjusted risk ratios (RRs) with 95% CIs. At follow-up, 1822 (40.6%) women and 1578 (51.9%) men reported recovery from chronic LBP. The probability of recovery was inversely associated with number of pain sites (P-trend<0.001). Compared with reporting 2–3 pain sites, persons with only LBP had a slightly higher probability of recovery (RR 1.10, 95% CI 0.98 to 1.22 in women and RR 1.10, 95% CI 1.01 to 1.21 in men), whereas people reporting 6–9 pain sites had substantially lower probability of recovery (RR 0.58, 95% CI 0.52 to 0.63 in women and RR 0.70, 95% CI 0.63 to 0.79 in men). Poor/not so good self-rated general health, symptoms of anxiety and depression, and pain-related disability in work and leisure were all associated with reduced probability of recovery, but there was no statistical interaction between multisite pain and these comorbidities. Increasing number of pain sites was inversely associated with recovery from chronic LBP. In addition, factors such as poor self-rated health, psychological symptoms and pain-related disability may further reduce the probability of recovery from chronic LBP.