Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study.
Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study.
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DOI：
10.1097/j.pain.0000000000000817
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发表时间：
2017-05
期刊：
影响因子：
7.4
通讯作者：
Palermo TM
中科院分区：
文献类型：
--
作者：
Holley AL;Wilson AC;Palermo TM
针对预防致残疼痛的战略已被建议作为一项公共卫生优先事项，因此及早发现有不良后果风险的青年至关重要。目前有限的信息可用于预测哪些出现急性疼痛的青年有持续存在的风险。这项前瞻性纵向研究的目的是确定急性期的生物心理社会因素，这些因素可以预测新发肌肉骨骼（MSK）疼痛主因的青年过渡到持续疼痛。参与者是88名儿童和青少年（10-17岁），他们到急诊科（n=47）或骨科诊所（n=41）评估新的MSK疼痛主诉（持续时间< 1个月）。青少年进行了两次研究访问（T1 =疼痛发作后<1个月；T2 =随访4个月），在此期间，他们完成了问卷调查（评估疼痛特征、心理因素、睡眠质量），并参与了评估条件疼痛调节（CPM）的实验室任务。回归分析测试了纵向疼痛结局（疼痛持续性、疼痛相关残疾、生活质量）的T1预测因子。结果显示，在4个月的随访中，大约35%的年轻人有持续的疼痛，持续的疼痛由较差的CPM和女性预测。T1时较高的抑郁症状与T2时较高的疼痛相关残疾和较差的生活质量相关。研究结果强调了抑郁症状和疼痛调节在预测寻求治疗的青少年急性MSK疼痛持续性中的作用，并提出了儿童和青少年从急性MSK疼痛过渡到慢性MSK疼痛的潜在机制。
Strategies directed at the prevention of disabling pain have been suggested as a public health priority, making early identification of youth at risk for poor outcomes critical. At present limited information is available to predict which youth presenting with acute pain are at risk for persistence. The aims of this prospective longitudinal study were to identify biopsychosocial factors in the acute period that predict the transition to persistent pain in youth with new-onset musculoskeletal (MSK) pain complaints. Participants were 88 children and adolescents (age 10–17 years) presenting to the emergency department (n=47) or orthopedic clinic (n=41) for evaluation of a new MSK pain complaint (< 1 month duration). Youth presented for two study visits (T1 = <1 month post pain onset; T2 = 4 month follow-up) during which they completed questionnaires (assessing pain characteristics, psychological factors, sleep quality) and participated in a lab task assessing conditioned pain modulation (CPM). Regression analyses tested T1 predictors of longitudinal pain outcomes (pain persistence, pain-related disability, quality of life). Results revealed approximately 35% of youth had persistent pain at 4-month follow-up, with persistent pain predicted by poorer CPM and female sex. Higher depressive symptoms at T1 were associated with higher pain-related disability and poorer quality of life at T2. Findings highlight the roles of depressive symptoms and pain modulation in longitudinally predicting pain persistence in treatment-seeking youth with acute MSK pain, and suggest potential mechanisms in the transition from acute to chronic MSK pain in children and adolescents.