Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma factors
Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma factors
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DOI：
10.1016/j.pain.2007.03.032
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发表时间：
2008-01-01
期刊：
影响因子：
7.4
通讯作者：
Hubbard, David
中科院分区：
文献类型：
--
作者：
Casey, Corinna Young;Greenberg, Melanie A.;Hubbard, David
本研究评估了急性颈部和背部疼痛进展为慢性疼痛和残疾的理论和经验为基础的模型，从慢性疼痛，认知，压力和创伤的文献。临床信息和标准化的创伤事件暴露（TLEQ），抑郁情绪（CES-D），疼痛（DIDS），身体残疾（PDI）和疼痛信念（PBPI）的社会心理措施，收集了84例急性背痛患者在急性背部诊所超过3个月的基线。路径分析用于纵向预测知觉疼痛和残疾。预测模型解释了持续性疼痛强度方差的26%和3个月时感知身体残疾方差的58%。更多地暴露于过去的创伤性生活事件和抑郁情绪是最预测慢性疼痛，抑郁情绪和消极的疼痛信念是最预测慢性残疾。更多的累积性创伤性生活事件，在新的疼痛发作的早期阶段更高水平的抑郁，以及早期认为疼痛可能是永久性的，这些都显著增加了随后疼痛和残疾的严重程度。需要在更大的样本中进行复制以确认这些路径。早期发现抑郁症状升高和高创伤暴露可能会识别出患慢性疼痛综合征的风险更大的个体，这些个体可能会从早期多学科干预中受益。(c)2007年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
This study evaluated a theoretically and empirically based model of the progression of acute neck and back pain to chronic pain and disability, developed from the literature in chronic pain, cognition, and stress and trauma. Clinical information and standardized psychosocial measures of cumulative traumatic events exposure (TLEQ), depressed mood (CES-D), pain (DIDS), physical disability (PDI), and pain beliefs (PBPI) were collected at baseline from 84 acute back pain patients followed at an Acute Back Clinic over 3 months. Path analysis was used for the longitudinal prediction of perceived pain and disability. The predictive model accounted for 26% of the variance in persistent pain intensity and 58% of the variance in perceived physical disability at 3 months. Greater exposure to past traumatic life events and depressed mood were most predictive of chronic pain; depressed mood and negative pain beliefs were most predictive of chronic disability. More cumulative traumatic life events, higher levels of depression in the early stages of a new pain episode, and early beliefs that pain may be permanent significantly contribute to increased severity of subsequent pain and disability. Replication in a larger sample is desirable to confirm these paths. Early detection of elevated depressive symptoms and high trauma exposure may identify individuals at greater risk for developing chronic pain syndromes who may benefit from early multidisciplinary intervention. (c) 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.