Self-management practices among primary care patients with musculoskeletal pain and depression
Self-management practices among primary care patients with musculoskeletal pain and depression
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DOI：
10.1007/s10865-008-9156-5
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发表时间：
2008-08-01
影响因子：
3.1
通讯作者：
Kroenke, Kurt
中科院分区：
文献类型：
--
作者：
Damush, Teresa M.;Wu, Jingwei;Kroenke, Kurt
本研究的目的是评估临床抑郁症对疼痛自我管理实践的影响。我们对情感障碍和肌肉骨骼疼痛分级护理（SCAMP）研究的基线数据进行了横断面分析。参与者包括250例疼痛和共病抑郁症患者和250例仅疼痛患者，并从城市大学和VA初级保健诊所招募。肌肉骨骼疼痛定义为腰痛、髋关节或膝关节疼痛≥ 3个月，并且至少中度，简明疼痛量表严重程度评分≥ 5。抑郁定义为PHQ-9评分≥ 10。我们使用多元Logistic和Poisson回归来评估抑郁和疼痛严重程度对两种核心疼痛自我管理技能（运动持续时间和认知策略）的个体和综合影响之间的关系。抑郁症患者每周的运动量比非抑郁症患者少，但表现出更频繁使用认知策略的趋势。在多变量分析中，抑郁症的严重程度大大减少了使用运动作为疼痛自我管理策略。相比之下，抑郁和疼痛的严重程度相互作用，增加了认知策略的使用。抑郁症和疼痛的严重程度对自我管理实践有不同的影响。了解有抑郁症和无抑郁症的疼痛患者的偏好策略之间的差异可能有助于定制疼痛自我管理程序。
The objective of this study was to assess the effect of clinical depression on pain self-management practices. We employed a cross-sectional analysis of baseline data from the Stepped Care for Affective disorders and Musculoskeletal Pain (SCAMP) study. Participants included 250 patients with pain and comorbid depression and 250 patients with pain only and were enrolled from urban university and VA primary care clinics. Musculoskeletal pain was defined as low back, hip or knee pain present >= 3 months and with at least a moderate, Brief Pain Inventory severity score >= 5. Depression was defined as a PHQ-9 score >= 10. We used multiple logistic and Poisson regression to assess the relationship between individual and combined effects of depression and pain severity on two core pain self-management skills: exercise duration and cognitive strategies. Depressed patients exercised less per week than did nondepressed patients but showed a trend towards more frequent use of cognitive strategies. On multivariable analysis, depression severity substantially decreased the use of exercise as a pain self-management strategy. In contrast, depression and pain severity interacted to increase the use of cognitive strategies. Depression and pain severity have differential effects on self-management practices. Understanding the differences between preferential strategies of pain patients with and without depression may be useful in tailoring pain self-management programs.