Von Korff Michael, Ormel Johan, Keefe Francis J, Dworkin Samuel F
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101 USA Duke University Medical Center, Durham, NC 27710 USA University of Washington Schools of Medicine and Dentistry, Seattle, WA 98195 USA.
Pain. 1992 Aug;50(2):133-149. doi: 10.1016/0304-3959(92)90154-4.
This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients. Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients. A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale. Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity. Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability. Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting. For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up. Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade. Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset. Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks. Chronic Pain Grade and pain-related functional limitations at 3-year follow-up. Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required. Pain persistence, measured by days in pain in a fixed time period, provides useful additional information.
本研究开发并评估了一种用于一般人群调查和初级保健疼痛患者研究的慢性疼痛严重程度分级的简单方法。在一项针对初级保健背痛（n = 1213）、头痛（n = 779）和颞下颌关节紊乱疼痛（n = 397）患者的纵向研究中，对疼痛强度、残疾程度、持续性和发病近期性的测量指标进行了测试，以评估其对慢性疼痛严重程度分级的能力。古特曼量表分析表明，疼痛强度和残疾程度测量指标形成了一个可靠的层次量表。疼痛强度测量指标似乎对整体严重程度的较低范围进行分级，而残疾程度测量指标似乎对整体严重程度的较高范围进行分级。发病近期性和过去6个月的疼痛天数与疼痛强度或残疾程度无关。使用简单的评分规则，疼痛严重程度被分为4个层次类别：I级，低残疾——低强度；II级，低残疾——高强度；III级，高残疾——中度受限；IV级，高残疾——严重受限。对于每个疼痛部位，基线时测量的慢性疼痛分级与失业率、与疼痛相关的功能限制、抑郁、自我健康评价为一般到较差、频繁使用阿片类镇痛药以及在基线和1年随访时频繁因疼痛就诊均呈现高度统计学显著且单调递增的关系。疼痛天数与这些变量相关，但不如慢性疼痛分级密切。与发病时间较早的人相比，近期发病病例（在过去3个月内首次发病）在心理和行为功能障碍方面没有差异。使用基于人群研究（n = 803）的纵向数据，基线时的慢性疼痛分级可预测过去2周内是否存在疼痛。在3年随访时的慢性疼痛分级和与疼痛相关的功能限制。当需要对整体疼痛严重程度进行简短的有序测量时，根据疼痛强度和与疼痛相关的残疾程度对慢性疼痛进行分级可能会很有用。通过固定时间段内的疼痛天数来衡量的疼痛持续性提供了有用的额外信息。
