White Peter D, Henderson Moira, Pearson Richard M, Coldrick Aruna R, White Anthony G, Kidd Bruce L
Department of Psychological Medicine, Queen Mary School of Medicine and Dentistry, University of London, UK.
J Rheumatol. 2003 Jan;30(1):139-45.
To compare behavioral and other psychosocial factors in patients with diffuse upper limb pain disorder (ULPD) and patients with carpal tunnel syndrome (CTS).
We compared 37 hospital outpatients with diffuse ULPD with 36 hospital outpatients with CTS, matched by sex, pain intensity, and duration of illness. We assessed psychiatric morbidity by a standardized interview, and both symptoms and personality by self-rated questionnaires. We measured illness behavior by assessing financial benefits and compensation, coping strategies, illness beliefs, treatments received, and 24 hours of monitoring movements of the most affected arm and the body as a whole.
There were no significant differences in the prevalence of either current or premorbid psychiatric disorders, personality scores, symptom amplification, disability, or treatments received. Subjects with ULPD had significantly lower self-rated scores for depression, somatic distress, sleep disturbance, and physical fatigue than subjects with CTS, although there were more than normal levels of anxiety, fatigue, and sleep disturbance in both groups. There were no significant differences in the numbers of arm or body movements by day and night. Significantly more ULPD subjects had been involved in litigation, but litigating patients were a minority.
The primary etiology of endemic diffuse ULPD, presenting in secondary care, is no more psychiatric, psychological, behavioral, or related to personality than is the case with a similarly chronic and painful condition of known pathology. We cannot exclude either a specific role for psychosocial factors at work, or a more general role for psychosocial factors in maintaining disability in patients with chronic pain.
比较弥漫性上肢疼痛障碍（ULPD）患者与腕管综合征（CTS）患者的行为及其他心理社会因素。
我们将37例弥漫性ULPD门诊患者与36例CTS门诊患者进行比较，两组在性别、疼痛强度和病程方面相匹配。我们通过标准化访谈评估精神疾病发病率，并通过自评问卷评估症状和性格。我们通过评估经济利益和赔偿、应对策略、疾病信念、接受的治疗，以及对受影响最严重的手臂和整个身体进行24小时的运动监测来衡量疾病行为。
当前或病前精神疾病的患病率、性格得分、症状放大、残疾程度或接受的治疗方面均无显著差异。与CTS患者相比，ULPD患者在抑郁、躯体困扰、睡眠障碍和身体疲劳方面的自评得分显著更低，尽管两组的焦虑、疲劳和睡眠障碍水平均高于正常。白天和晚上手臂或身体的活动次数无显著差异。参与诉讼的ULPD患者明显更多，但进行诉讼的患者占少数。
在二级医疗中出现的地方性弥漫性ULPD的主要病因，与已知病理的类似慢性疼痛疾病相比，在精神、心理、行为或与性格方面并无更多关联。我们既不能排除心理社会因素在其中的特定作用，也不能排除心理社会因素在维持慢性疼痛患者残疾状态方面的更普遍作用。
