van der Windt Danielle, Croft Peter, Penninx Brenda
Institute for Research in Extramural Medicine Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands.
J Rheumatol. 2002 Mar;29(3):564-9.
To investigate the association between the extent of pain and the severity of psychological distress in neck and upper limb pain, and to establish whether extent of pain is associated with consultation frequency in primary care.
The study population was selected from responders to a general health survey conducted in a general practice in North Staffordshire, UK. Responders indicating pain in the neck or upper limb area were included. The survey included the Hospital Anxiety and Depression Scale (HADS). Consultation data were retrieved for a period of 12 months following the survey.
A total of 867 responders had experienced neck-upper limb pain in the month preceding the survey (33% of all responders). Responders with more generalized pain within the neck-upper limb area had significantly higher HADS scores compared to responders with pain in one area only, particularly for depression (median scores 5 vs 3 points). Annual consultation frequency was also higher among responders with generalized pain [adjusted OR for high consultation frequency (> or = 7 visits vs 0-2 visits) 1.6, 95% CI 1.1 to 2.4]. When the analysis was restricted to consultations specifically related to neck-upper limb pain, the association between extent of pain and consultation frequency was weak and not statistically significant.
Our survey revealed a significant association between extent of pain in the neck-upper limb area and psychological distress, although scores for anxiety and depression were generally low, with only a small proportion of responders reporting moderate or severe symptoms. Responders with both generalized pain and depressive symptoms were more likely to consult their family doctor, but not specifically for musculoskeletal pain. These results confirm the hypothesis that general psychological well being rather than specific somatic symptoms predict consultation frequency.
探讨颈部和上肢疼痛的疼痛程度与心理困扰严重程度之间的关联，并确定疼痛程度是否与初级保健中的就诊频率相关。
研究人群选自英国北斯塔福德郡一家普通诊所进行的一般健康调查的应答者。纳入表示颈部或上肢区域疼痛的应答者。该调查包括医院焦虑抑郁量表（HADS）。在调查后的12个月内检索就诊数据。
共有867名应答者在调查前一个月经历过颈部 - 上肢疼痛（占所有应答者的33%）。与仅在一个区域疼痛的应答者相比，颈部 - 上肢区域疼痛更广泛的应答者的HADS得分显著更高，尤其是在抑郁方面（中位数得分分别为5分和3分）。疼痛广泛的应答者的年度就诊频率也更高[高就诊频率（≥7次就诊与0 - 2次就诊相比）的调整后比值比为1.6，95%置信区间为1.1至2.4]。当分析仅限于与颈部 - 上肢疼痛具体相关的就诊时，疼痛程度与就诊频率之间的关联较弱且无统计学意义。
我们的调查显示，颈部 - 上肢区域的疼痛程度与心理困扰之间存在显著关联，尽管焦虑和抑郁得分总体较低，只有一小部分应答者报告有中度或重度症状。既有广泛疼痛又有抑郁症状的应答者更有可能咨询他们的家庭医生，但并非专门针对肌肉骨骼疼痛。这些结果证实了这样的假设，即总体心理健康状况而非特定的躯体症状可预测就诊频率。
