Boersma Katja, Linton Steven J
Department of Occupational and Environmental Medicine, Orebro University Hospital, Orebro, Sweden.
Clin J Pain. 2005 Jan-Feb;21(1):38-43; discussion 69-72. doi: 10.1097/00002508-200501000-00005.
There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability. Identifying patients at risk for this development is an important step. Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening questionnaire exist. Moreover, the objective was to then relate these groups to future outcomes, for example, sick leave as an impetus for developing tailored interventions that might better prevent chronic problems. A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Orebro Musculoskeletal Pain Screening Questionnaire and were then followed to determine outcome. Cluster analysis was used to identify subgroups. Validity was tested using 3 methods including the split-half technique. The subgroups were compared prospectively on outcome measures obtained 1 year later. Using pain intensity, fear-avoidance beliefs, function, and mood, we found 4 distinct profiles: Fear-Avoidant, Distressed Fear-Avoidant, Low Risk, and Low Risk-Depressed Mood. These 4 subgroups were also robust in all 3 of the validity procedures. The 4 subgroups were clearly related to outcome. Although the low risk profiles had virtually no one developing long-term sick leave, the Fear-Avoidant profile had 35% and the Distressed Fear-Avoidant profile 62% developing long-term sick leave. Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification. Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability.
迫切需要提供有效的早期干预措施，以防止持续性疼痛和残疾的发展。识别有这种发展风险的患者是重要的一步。我们的目的是探讨在一份筛查问卷上具有相似反应模式的个体是否存在不同的亚组。此外，目标是将这些组与未来的结果联系起来，例如，将病假作为制定可能更好地预防慢性问题的针对性干预措施的动力。共有363名因急性或亚急性脊柱疼痛寻求初级保健的患者完成了厄勒布鲁肌肉骨骼疼痛筛查问卷，然后对其进行随访以确定结果。使用聚类分析来识别亚组。使用包括对分技术在内的3种方法测试有效性。对1年后获得的结果测量指标对亚组进行前瞻性比较。利用疼痛强度、恐惧回避信念、功能和情绪，我们发现了4种不同的类型：恐惧回避型、痛苦恐惧回避型、低风险型和低风险抑郁情绪型。这4个亚组在所有3种有效性程序中也都很稳健。这4个亚组与结果明显相关。虽然低风险类型几乎没有人休长期病假，但恐惧回避型有35%，痛苦恐惧回避型有62%的人休长期病假。我们的结果表明，恐惧回避和痛苦是与疼痛相关残疾发展的重要因素，可能作为早期识别的关键。针对这些类型中分离出的因素提供干预措施应能加强对持续性疼痛和残疾的预防。
