Badcock Louisa J, Lewis Martyn, Hay Elaine M, Croft Peter R
Primary Care Sciences Research Centre, University of Keele, Stoke-on-Trent, Staffordshire ST5 5BG, UK.
J Rheumatol. 2003 Dec;30(12):2694-9.
Despite the high prevalence of shoulder-neck pain in the community, and the fact that it is commonly a persistent and disabling condition, only a minority of sufferers seek medical help. We investigated the association between primary care consultation and subsequent outcome in a cohort of shoulder-neck pain sufferers.
A population with unilateral shoulder-neck pain was identified by a questionnaire mailed to 4002 adults randomly selected from the register of one family practice. Subjects were asked to shade areas of pain on a blank manikin, and give demographic details and scales of pain, anxiety, and depression. For the following 2 years, general practitioner (GP) consultations for shoulder and neck problems were determined using the practice database. The persistence of pain and degree of shoulder-specific disability, as well as general health status using the Medical Outcome Study Short Form-36 (SF-36), were assessed by means of a second postal survey at 2 years' followup.
Three hundred four subjects (11.7% of questionnaire responders) had unilateral shoulder-neck pain at baseline, and 224 were included in the study analyses. Of these, 47 (21%) consulted their GP for shoulder-neck problems over the 2 years. Of the 47 consulters, 36 (77%) reported shoulder-neck pain at followup; this was a higher percentage than that for nonconsulters (RRadjusted = 1.3). Among all subjects with persistent shoulder-neck pain, consulters were more likely than nonconsulters to have shoulder related disability at followup (RRadjusted = 1.6). On average, consulters had more pain and lower levels of physical functioning at followup than nonconsulters as measured by the SF-36.
The minority of shoulder-neck pain sufferers who consult a primary care practitioner do not have better subsequent pain and disability outcomes than those who do not consult. Our findings raise questions about the current influence of medical care on the natural history of this condition.
尽管社区中肩颈痛的患病率很高，且它通常是一种持续性的致残性疾病，但只有少数患者寻求医疗帮助。我们在一组肩颈痛患者中调查了初级保健咨询与后续结局之间的关联。
通过向从一家家庭诊所登记册中随机抽取的4002名成年人邮寄问卷，确定了患有单侧肩颈痛的人群。受试者被要求在空白人体模型上标记疼痛区域，并提供人口统计学细节以及疼痛、焦虑和抑郁量表。在接下来的两年中，使用诊所数据库确定因肩颈问题进行的全科医生（GP）咨询情况。在随访2年时通过第二次邮寄调查评估疼痛的持续性、肩部特定残疾程度以及使用医学结局研究简表36（SF - 36）评估的总体健康状况。
304名受试者（问卷回复者的11.7%）在基线时患有单侧肩颈痛，224名被纳入研究分析。其中，47名（21%）在两年内就肩颈问题咨询了他们的全科医生。在这47名咨询者中，36名（77%）在随访时报告有肩颈痛；这一比例高于未咨询者（调整后相对危险度 = 1.3）。在所有持续存在肩颈痛的受试者中，咨询者在随访时比未咨询者更有可能出现与肩部相关的残疾（调整后相对危险度 = 1.6）。根据SF - 36测量，平均而言，咨询者在随访时比未咨询者有更多疼痛且身体功能水平更低。
咨询初级保健医生的少数肩颈痛患者在后续的疼痛和残疾结局方面并不比未咨询者更好。我们的研究结果对当前医疗护理对这种疾病自然史的影响提出了疑问。
