Aaron Leslie A, Arguelles Lester M, Ashton Suzanne, Belcourt Megan, Herrell Richard, Goldberg Jack, Smith Wayne R, Buchwald Debra
Department of Oral Medicine, University of Washington, Seattle, Washington 98195, USA.
J Rheumatol. 2002 Nov;29(11):2426-34.
To examine the independent effects of chronic regional and widespread pain syndromes on health and functional status after accounting for comorbid chronic fatigue using a co-twin control design.
We identified 95 twin pairs discordant for pain in which one twin had chronic regional or widespread pain and the other denied chronic pain. Demographic data, functional and psychological status, health behaviors, and symptoms based on the 1994 criteria for chronic fatigue syndrome (CFS) were assessed by questionnaire. Psychiatric diagnoses were based on structured interview. Random effects regression modeling estimated associations between chronic regional and widespread pain and each health measure with and without adjustment for CFS.
Significant differences (p </= 0.05) were found within twin pairs discordant for chronic regional and widespread pain, for general health perception, and physical and mental health functioning as measured by summary scores from the Short Form-36. In addition, differences were observed within pain discordant pairs in psychological distress as measured by the General Health Questionnaire as well as the number of psychiatric diagnoses. Adjustment for CFS eliminated the association between chronic pain and mental health, but the association between chronic pain and poor general health, physical functioning, and sleep quality persisted (p </= 0.01). Only the intra-pair difference in physical functioning distinguished twins with regional vs widespread pain (p </= 0.05).
Both chronic regional and widespread pain exact debilitating effects on perceived general health, physical functioning, and sleep quality independent of CFS. However, the psychological and psychiatric influence of chronic pain appears closely tied to CFS. Research should examine the additive role of CFS-like illnesses in patients with chronic pain, and its influence on treatment and outcome.
采用双生子对照设计，在考虑合并慢性疲劳的情况下，研究慢性局部和广泛性疼痛综合征对健康和功能状态的独立影响。
我们确定了95对疼痛不一致的双胞胎，其中一个双胞胎患有慢性局部或广泛性疼痛，另一个否认有慢性疼痛。通过问卷调查评估人口统计学数据、功能和心理状态、健康行为以及基于1994年慢性疲劳综合征（CFS）标准的症状。精神科诊断基于结构化访谈。随机效应回归模型估计了慢性局部和广泛性疼痛与每项健康指标之间的关联，同时对CFS进行了调整和未调整。
在慢性局部和广泛性疼痛不一致的双胞胎对中，通过简短形式-36的总结分数衡量的总体健康感知、身心健康功能存在显著差异（p≤0.05）。此外，在疼痛不一致的双胞胎对中，通过一般健康问卷测量的心理困扰以及精神科诊断数量也存在差异。对CFS进行调整消除了慢性疼痛与心理健康之间的关联，但慢性疼痛与总体健康不佳、身体功能和睡眠质量之间的关联仍然存在（p≤0.01）。只有身体功能的双生子对内差异区分了患有局部疼痛与广泛性疼痛的双胞胎（p≤0.05）。
慢性局部和广泛性疼痛均对总体健康感知、身体功能和睡眠质量产生衰弱性影响，且独立于CFS。然而，慢性疼痛的心理和精神影响似乎与CFS密切相关。研究应探讨类CFS疾病在慢性疼痛患者中的附加作用及其对治疗和结局的影响。
