McBeth J, Macfarlane G J, Hunt I M, Silman A J
Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
Rheumatology (Oxford). 2001 Jan;40(1):95-101. doi: 10.1093/rheumatology/40.1.95.
Chronic widespread pain is the cardinal clinical feature of the fibromyalgia syndrome, which, in the majority of clinic patients, is persistent. By contrast, in community-derived patients, pain is persistent in only half of the affected individuals, particularly those with psychological distress. Whether such distress is a consequence of the pain or a manifestation of a wider process of somatization which is associated with the persistence of pain is unclear.
We tested in a large, prospective, population-based study the hypothesis that features of somatization predict the persistence of chronic widespread pain.
In all, 252 (13%) of 1953 adult subjects selected from a population register were classified as having chronic widespread pain based on a detailed questionnaire which included a pain drawing. The patients also completed a number of psychosocial instruments which measure features known to be associated with somatization. Two hundred and twenty-five (91%) of the patients were successfully followed up after 12 months and provided data on pain status using the same instruments.
In all, 126 (56%) patients reported chronic widespread pain at follow-up, 74 (33%) reported other pain and 25 (11%) reported no pain. Persistent chronic widespread pain was strongly associated with baseline test scores for high psychological distress and fatigue. In addition, these subjects were more likely to display a pattern of illness behaviour characterized by frequent visits to medical practitioners for symptoms which disrupt daily activities. The prevalence of persistent pain increased with the number of risk factors the subjects were exposed to.
Although almost half of the cases of chronic widespread pain resolved within 1 yr, this study has demonstrated for the first time that those subjects who display features of somatization are more likely to have widespread pain which persists. These findings have implications for the identification and treatment of persons with persistent chronic widespread pain.
慢性广泛性疼痛是纤维肌痛综合征的主要临床特征，在大多数临床患者中，疼痛是持续性的。相比之下，在社区患者中，只有一半的受影响个体存在持续性疼痛，特别是那些有心理困扰的患者。这种困扰是疼痛的结果还是与疼痛持续相关的更广泛躯体化过程的表现尚不清楚。
我们在一项大型、前瞻性、基于人群的研究中检验了躯体化特征预测慢性广泛性疼痛持续性的假设。
从人口登记册中选取的1953名成年受试者中，共有252名（13%）根据一份详细问卷（包括疼痛绘图）被归类为患有慢性广泛性疼痛。患者还完成了一些心理社会测评工具，这些工具测量已知与躯体化相关的特征。12个月后，225名（91%）患者成功接受随访，并使用相同工具提供了疼痛状况数据。
随访时，共有126名（56%）患者报告有慢性广泛性疼痛，74名（33%）报告有其他疼痛，25名（11%）报告无疼痛。持续性慢性广泛性疼痛与高心理困扰和疲劳的基线测试分数密切相关。此外，这些受试者更有可能表现出一种疾病行为模式，其特征是因干扰日常活动的症状而频繁就医。持续性疼痛的患病率随着受试者接触的风险因素数量增加而上升。
虽然几乎一半的慢性广泛性疼痛病例在1年内缓解，但本研究首次表明，表现出躯体化特征的受试者更有可能出现持续性广泛性疼痛。这些发现对持续性慢性广泛性疼痛患者的识别和治疗具有启示意义。
