Persistent pain and well-being - A World Health Organization study in primary care
Persistent pain and well-being - A World Health Organization study in primary care
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DOI：
10.1001/jama.280.2.147
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发表时间：
1998-07-08
影响因子：
120.7
通讯作者：
Gater, R
中科院分区：
文献类型：
--
作者：
Gureje, O;Von Korff, M;Gater, R
背景。-关于不同文化中持续性疼痛程度的信息很少。尽管疼痛是寻求医疗保健的常见原因，但有关初级保健患者持续疼痛的频率和影响的信息是不够的。评估持续性疼痛在初级保健患者中的患病率和影响。调查数据是从初级保健患者的代表性样本中收集的，作为世界卫生组织在亚洲，非洲，欧洲和美洲的15个中心进行的一般卫生保健心理问题合作研究的一部分。年龄在大多数人（通常为18岁）和65岁之间的连续初级保健参加者进行了筛选（n = 25 916）和分层随机抽样采访（n = 5438）。持续性疼痛，定义为疼痛存在的大部分时间为6个月或以上的一段时间在前一年，和心理疾病进行了评估的复合国际诊断访谈，残疾评估格罗宁根社会残疾时间表和活动限制天在前一个月。在所有15个中心中，22%的初级保健患者报告持续性疼痛，但各中心的患病率差异很大（范围，5.5%-33.0%）。相对于没有持续疼痛的患者，疼痛患者更容易患有焦虑或抑郁症（调整后的比值比[OR]，4，14，95%置信区间[CI]，3.52-4.86），发生显著活动受限（调整后的OR，1.63; 95%CI，1.41-1.89），并有不利的健康观念（调整OR，1.26; 95%CI，1.07-1.49），观察各中心心理障碍与持续性疼痛的关系，而残疾和持续性疼痛之间的关系在各中心之间并不一致。持续性疼痛是初级保健患者中常见的健康问题，并且与各中心的心理疾病一致相关。各中心之间持续性疼痛和残疾之间的频率差异很大，并且关系不一致，这表明，当比较基于从每种文化中有限数量的医疗保健环境中抽取的患者样本时，在得出关于文化在塑造对持续性疼痛的反应中的作用的结论时要谨慎。
Context.-There is little information on the extent of persistent pain across cultures. Even though pain is a common reason for seeking health care, information on the frequency and impacts of persistent pain among primary care patients is inadequate.Objective.-To assess the prevalence and impact of persistent pain among primary care patients.Design and Setting.-Survey data were collected from representative samples of primary care patients as part of the World Health Organization Collaborative Study of Psychological Problems in General Health Care, conducted in 15 centers in Asia, Africa, Europe, and the Americas.Participants.-Consecutive primary care attendees between the age of majority (typically 18 years) and 65 years were screened (n = 25 916) and stratified random samples interviewed (n = 5438).Main Outcome Measures.-Persistent pain, defined as pain present most of the time for a period of 6 months or more during the prior year, and psychological illness were assessed by the Composite International Diagnostic interview, Disability was assessed by the Groningen Social Disability Schedule and by activity-limitation days in the prior month.Results.-Across all 15 centers, 22% of primary care patients reported persistent pain, but there was wide variation in prevalence rates across centers (range, 5.5%-33.0%). Relative to patients without persistent pain, pain sufferers were more likely to have an anxiety or depressive disorder (adjusted odds ratio [OR], 4, 14, 95% confidence interval [CI], 3.52-4.86), to experience significant activity limitations (adjusted OR, 1.63; 95% CI, 1.41-1.89), and to have unfavorable health perceptions (adjusted OR, 1.26; 95% CI, 1.07-1.49), The relationship between psychological disorder and persistent pain was observed in every center, while the relationship between disability and persistent pain was inconsistent across centers.Conclusions.-Persistent pain was a commonly reported health problem among primary care patients and was consistently associated with psychological illness across centers. Large variation in frequency and the inconsistent relationship between persistent pain and disability across centers suggests caution in drawing conclusions about the role of culture in shaping responses to persistent pain when comparisons are based on patient samples drawn from a limited number of health care settings in each culture.