Potter R G, Jones J M
Centre for Epidemiology, Public Health Medicine and Primary Health Care, University of Keele.
Br J Gen Pract. 1992 Nov;42(364):462-4.
Little is known about the evolution of chronic pain in primary care. Forty five patients with a four week history of musculoskeletal pain were assessed and followed up over 26 weeks by a research nurse using a structured interview and formal assessment instruments. Patients aged 18 to 65 years were recruited on presentation at two semirural Cheshire general practices and subsequently interviewed on a domiciliary visit. Twenty patients (44%) continued to have pain at 26 weeks and these patients were considered to have chronic pain. Nineteen patients had no pain after 12 weeks and a further six had no pain after 26 weeks; these patients together formed the group with acute pain. Comparing the two groups at entry into the study (pain of four weeks' duration) demonstrated significantly higher visual analogue scale scores for intensity of pain (P < 0.01) and a higher incidence of depression (P < 0.01) in the group which subsequently developed chronic pain. In this group, the presence of depression at 12 weeks was associated with higher visual analogue scale scores (P < 0.05) but at 26 weeks scores were similar in depressed and non-depressed patients. The correlation between visual analogue scale score for intensity of pain and the use of passive coping strategies to cope with pain appeared more strongly positive with duration of pain (P < 0.05 at 26 weeks). It is suggested that high pain intensity scores, the presence of depression, and the increasing use of passive coping strategies may be identifiable associations with the development of chronic pain. Areas for further research are identified.
关于基层医疗中慢性疼痛的演变情况，人们了解得很少。一名研究护士使用结构化访谈和正式评估工具，对45名有四周肌肉骨骼疼痛病史的患者进行了评估，并随访了26周。年龄在18至65岁之间的患者在柴郡两个半乡村全科诊所就诊时被招募，随后在一次家访中接受访谈。20名患者（44%）在26周时仍有疼痛，这些患者被认为患有慢性疼痛。19名患者在12周后不再疼痛，另有6名患者在26周后不再疼痛；这些患者共同构成了急性疼痛组。在研究开始时（四周病程的疼痛）比较两组发现，随后发展为慢性疼痛的组在疼痛强度的视觉模拟量表评分显著更高（P < 0.01），抑郁症发病率更高（P < 0.01）。在该组中，12周时抑郁症的存在与更高的视觉模拟量表评分相关（P < 0.05），但在26周时，抑郁和非抑郁患者的评分相似。疼痛强度的视觉模拟量表评分与使用被动应对策略来应对疼痛之间的相关性，随着疼痛持续时间的延长似乎呈更强的正相关（26周时P < 0.05）。有人提出，高疼痛强度评分、抑郁症的存在以及被动应对策略的使用增加，可能是与慢性疼痛发展相关的可识别关联。确定了进一步研究的领域。
