Picavet H Susan J, Vlaeyen Johan W S, Schouten Jan S A G
Department of Chronic Disease Epidemiology, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Am J Epidemiol. 2002 Dec 1;156(11):1028-34. doi: 10.1093/aje/kwf136.
By using a population-based cohort of the general Dutch population, the authors studied whether an excessively negative orientation toward pain (pain catastrophizing) and fear of movement/(re)injury (kinesiophobia) are important in the etiology of chronic low back pain and associated disability, as clinical studies have suggested. A total of 1,845 of the 2,338 inhabitants (without severe disease) aged 25-64 years who participated in a 1998 population-based questionnaire survey on musculoskeletal pain were sent a second questionnaire after 6 months; 1,571 (85 percent) participated. For subjects with low back pain at baseline, a high level of pain catastrophizing predicted low back pain at follow-up (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.0, 2.8) and chronic low back pain (OR = 1.7, 95% CI: 1.0, 2.3), in particular severe low back pain (OR = 3.0, 95% CI: 1.7, 5.2) and low back pain with disability (OR = 3.0, 95% CI: 1.7, 5.4). A high level of kinesiophobia showed similar associations. The significant associations remained after adjustment for pain duration, pain severity, or disability at baseline. For those without low back pain at baseline, a high level of pain catastrophizing or kinesiophobia predicted low back pain with disability during follow-up. These cognitive and emotional factors should be considered when prevention programs are developed for chronic low back pain and related disability.
通过对荷兰普通人群进行基于人群的队列研究，作者探讨了如临床研究所提示的，对疼痛过度消极的态度（疼痛灾难化）以及对运动/（再）损伤的恐惧（运动恐惧症）在慢性下腰痛及其相关残疾的病因中是否起重要作用。在参与了1998年基于人群的肌肉骨骼疼痛问卷调查的2338名25 - 64岁（无严重疾病）的居民中，共有1845人在6个月后收到了第二份问卷；1571人（85%）参与了调查。对于基线时有下腰痛的受试者，高水平的疼痛灾难化预示着随访时的下腰痛（优势比（OR）= 1.7，95%置信区间（CI）：1.0，2.8）以及慢性下腰痛（OR = 1.7，95%CI：1.0，2.3），尤其是严重下腰痛（OR = 3.0，95%CI：1.7，5.2）和伴有残疾的下腰痛（OR = 3.0，95%CI：1.7，5.4）。高水平的运动恐惧症也显示出类似的关联。在对基线时的疼痛持续时间、疼痛严重程度或残疾情况进行调整后，这些显著关联依然存在。对于基线时无下腰痛的人，高水平的疼痛灾难化或运动恐惧症预示着随访期间会出现伴有残疾的下腰痛。在制定针对慢性下腰痛及相关残疾的预防计划时，应考虑这些认知和情感因素。
