A prognostic approach to defining chronic pain
A prognostic approach to defining chronic pain
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DOI：
10.1016/j.pain.2005.06.017
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发表时间：
2005-10-01
期刊：
影响因子：
7.4
通讯作者：
Miglioretti, DL
中科院分区：
文献类型：
--
作者：
Von Korff, M;Miglioretti, DL
本文发展了一种预后的方法来定义慢性背痛。可能和很可能的慢性背痛分别定义为50%和80%（或更高）的未来临床显著背痛的概率。我们在1213名初级保健背痛患者中评估了经验得出的慢性疼痛分类是否满足这些验证标准，这些患者在基线和1年、2年和5年随访时进行了评估。从背痛强度和功能障碍的多个测量值，潜伏转换回归分析经验性地确定了四种疼痛严重程度潜在类别：无疼痛;轻度疼痛;中度疼痛和限制;和严重，限制性疼痛。从一个观察点到下一个观察点，患者最有可能保持相同的疼痛严重程度，但慢性疼痛更好地表征为动态状态而不是静态特征。在重度限制性疼痛患者中，预后变量（抑郁、弥漫性疼痛、疼痛持续性）改善了对未来重度限制性疼痛的预测。根据疼痛严重程度和预后指标确定的风险评分对应于预测未来临床显著背痛的50%和80%概率阈值。在基线和1年时，6.1%和4.4%的研究患者达到或超过可能的慢性背痛的80%风险阈值。另外20.3%的基线和12.5%的第一年达到或超过50%的可能慢性背痛的风险阈值。通过未来临床显著疼痛的风险阈值前瞻性定义慢性疼痛，提供了一种基于经验的慢性疼痛评估方法。(c)2005年由Elsevier B. V.代表国际疼痛研究协会出版。
This paper develops a prognostic approach to defining chronic back pain. Possible and probable chronic back pain were defined, respectively, by a 50% and an 80% (or greater) probability of future clinically significant back pain. We assessed whether an empirically derived chronic pain classification satisfied these validating criteria among 1213 primary care back pain patients assessed at baseline and at 1, 2 and 5 year follow-ups. From multiple measures of back pain intensity and dysfunction, Latent Transition Regression Analysis empirically identified four pain severity latent classes: no pain; mild pain; moderate pain and limitation; and severe, limiting pain. From one observation point to the next, patients were most likely to remain in the same pain severity class, but chronic pain was better characterized as a dynamic state than a static trait. Among persons with severe, limiting pain, prognostic variables (depression, diffuse pain, pain persistence) improved prediction of future severe, limiting pain. A risk score developed from pain severity and prognostic measures identified risk levels corresponding to 50 and 80% probability thresholds for predicting future clinically significant back pain. At baseline and 1 year, 6.1 and 4.4% of study patients met or exceeded the 80% risk threshold for probable chronic back pain. An additional 20.3% at baseline and 12.5% at I year met or exceeded the 50% risk threshold for possible chronic back pain. Defining chronic pain prospectively, by risk thresholds for future clinically significant pain, provides an empirically grounded approach to chronic pain assessment. (c) 2005 Published by Elsevier B.V. on behalf of International Association for the Study of Pain.