Clinical characteristics of chronic back pain as a function of gender and oral opioid use
Clinical characteristics of chronic back pain as a function of gender and oral opioid use
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DOI：
10.1097/00007632-200301150-00010
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发表时间：
2003-01-15
期刊：
影响因子：
3
通讯作者：
Lowery, D
中科院分区：
文献类型：
--
作者：
Fillingim, RB;Doleys, DM;Lowery, D
研究设计.对在多学科疼痛治疗中心接受评估的慢性脊柱疼痛患者的数据进行了横断面分析。确定疼痛严重程度、心理状态和身体残疾是否因性别和阿片类药物使用而不同，以及慢性背痛女性和男性中阿片类药物使用的临床相关性是否不同。疼痛体验的性别差异已被广泛报道。例如，在一般人群中，几种慢性疼痛状况在女性中比男性中更普遍，许多实验研究表明女性的疼痛阈值和耐受性较低。此外，最近的实验性和急性临床疼痛研究的证据表明，镇痛药物的反应可能在女性和男性不同。该样本包括240名患者（35%为女性），他们患有下背部、上背部或颈部疼痛，正在多学科疼痛中心接受治疗评估。根据自我报告和病历审查，将患者分为阿片类药物或非阿片类药物使用者。所有患者都完成了一系列临床评估，包括疼痛严重程度，心理调整，自我报告的残疾，功能任务和疼痛耐受性的测量。进行分析，以检查临床变量作为性别和阿片类药物使用的函数。结果表明，阿片类药物的使用与女性和男性自我报告的残疾和功能较差有关。然而，阿片类药物使用与情感困扰的关联在女性和男性之间存在差异。使用阿片类药物的女性表现出较低的情感困扰，而使用阿片类药物的男性报告了更大的情感困扰。阿片类药物的使用与疼痛的严重程度无关，尽管女性报告的疼痛比男性更严重。这些研究结果表明，阿片类药物的使用和性别是慢性脊柱疼痛患者临床状态的重要预测因素。更有趣的是，这两个变量相互作用，因为阿片类药物的使用与男性情感困扰的增加有关，但女性的情况正好相反。此外，女性报告的疼痛严重程度更高，这与之前的一些研究结果一致。这些研究结果的潜在解释，并讨论了实际意义。
Study Design. A cross-sectional analysis of data derived from patients with chronic spinal pain undergoing evaluation at a multidisciplinary pain treatment center was conducted.Objective. To determine whether pain severity, psychological status, and physical disability differed as a function of gender and opioid use, and whether the clinical correlates of opioid use differed in women and men with chronic back pain.Summary of Background Data. Gender differences in the experience of pain have been widely reported. For example, in the general population, several chronic pain conditions are more prevalent among women than among men, and many experimental studies demonstrate lower pain thresholds and tolerances among women. In addition, recent evidence from studies of experimental and acute clinical pain suggests that responses to analgesic medications may differ in women and men.Methods. The sample consisted of 240 patients (35% women) with low back, upper back, or neck pain undergoing evaluation for treatment at a multidisciplinary pain center. The patients were classified as opioid or nonopioid users on the basis of self-report and medical record review. All the patients completed a battery of clinical assessments, including measures of pain severity, psychological adjustment, self-reported disability, functional tasks, and pain tolerance. Analyses were conducted to examine clinical variables as a function of gender and opioid use.Results. The results indicated that opioid use was associated with greater self-reported disability and poorer function in both women and men. However, the association of opioid use with affective distress differed between women and men. The women using opioids showed lower affective distress, whereas the opioid-using men reported greater affective distress. Opioid use was not associated with pain severity, although the women reported greater pain than men.Conclusions. These findings indicate that both opioid use and gender are significant predictors of clinical status of patients with chronic spinal pain. More interesting, these two variables interact because opioid use was associated with increased affective distress among the men, but the reverse was true for the women, In addition, the women reported greater pain severity, which is consistent with some previous findings. Potential explanations for these findings are presented, and the practical implications are discussed.