Raspe A, Matthis C, Héon-Klin V, Raspe H
Institut für Sozialmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.
Rehabilitation (Stuttg). 2003 Aug;42(4):195-203. doi: 10.1055/s-2003-41649.
Surveys with a main focus on back pain tend to isolate the complaint from possibly concomitant pains, other symptoms and disorders. Severe chronic back pain is assumed here to imply more than pain in the back.
We report results from a two stage survey conducted in 1998 - 2000. The initial postal questionnaire addressed all 10,000 actively employed blue collar workers from a regional pension fund (Landesversicherungsanstalt Schleswig-Holstein) aged 40 - 54 and residing in or around Luebeck/Germany (68 % males). Subjects reporting severe and disabling back pain were invited to a socio-medical examination. The response and participation rates were 58 % and 65 % respectively. Non-response and non-participation seem to result in minor though opposite, effects.
The prevalence of current back pain (back pain of any severity within the past 7 days) is high (68 %; including 16 % with severe, disabling back pain) despite the preponderance of males and a probable healthy worker effect. 82 % of subjects participating in the second round reported recurrent or persisting back pain on the day of examination, in the majority with a chronic fluctuating and overall deteriorating course pattern. 18 % reported no current back pain and hence gave prospective (and additionally retrospective) evidence of an episodic-intermittent course of the disorder. The former group showed significantly more pains, bodily complaints, dysfunctional cognitions, emotional distress and concomitant disorders. 35 % of them indicated back pain as their dominant health problem; 49 % identified back pain and another disorder as dominant, and 16 % reported other prominent health problems. More than 70 % of "other" disorders originated from the musculoskeletal system often involving the extremities.
Back pain is very common among blue collar workers. Severe disabling back pain is usually associated with numerous other pains, bodily complaints, disorders, and indicators of psychological distress ("amplified back pain"). However, even amplified back pain is not always the sole or dominant health problem. Assessing the degree of "amplification" seems helpful in splitting a previously homogeneous group of severely affected back pain sufferers-with possible prognostic and therapeutic consequences.
主要关注背痛的调查往往会将背痛主诉与可能伴随的疼痛、其他症状及疾病隔离开来。在此，严重慢性背痛被认为所指不止于背部疼痛。
我们报告了1998 - 2000年进行的两阶段调查结果。最初的邮政问卷面向来自石勒苏益格 - 荷尔斯泰因州地方养老基金的10000名在职蓝领工人，年龄在40 - 54岁之间，居住在德国吕贝克市或其周边地区（男性占68%）。报告有严重致残性背痛的受试者受邀参加社会医学检查。回复率和参与率分别为58%和65%。无回复和未参与似乎产生了虽小但相反的影响。
尽管男性占多数且可能存在健康工人效应，但当前背痛（过去7天内任何严重程度的背痛）的患病率仍很高（68%；包括16%有严重致残性背痛）。参加第二轮调查的受试者中，82%在检查当天报告有复发性或持续性背痛，大多数呈慢性波动且总体病情恶化的病程模式。18%报告当前无背痛，因此提供了该疾病发作性 - 间歇性病程的前瞻性（以及额外的回顾性）证据。前一组表现出明显更多的疼痛、身体不适、功能失调认知、情绪困扰及伴随疾病。其中35%表示背痛是其主要健康问题；49%认为背痛和另一种疾病是主要问题，16%报告有其他突出健康问题。超过70%的“其他”疾病源自肌肉骨骼系统，常累及四肢。
背痛在蓝领工人中非常常见。严重致残性背痛通常与许多其他疼痛、身体不适、疾病以及心理困扰指标（“复杂性背痛”）相关。然而，即使是复杂性背痛也并非总是唯一或主要的健康问题。评估“复杂性”程度似乎有助于区分先前同质的严重背痛患者群体，这可能产生预后和治疗方面的影响。
