Turk Dennis C
Department of Anesthesiology, University of Washington, Seattle, WA 98195, USA.
Clin J Pain. 2005 Jan-Feb;21(1):44-55; discussion 69-72. doi: 10.1097/00002508-200501000-00006.
A large and diverse number of treatments have been shown to be effective in reducing pain and other symptoms for a minority but statistically significant number of patients in different chronic pain syndromes. The means by which such different treatments achieve similar outcomes is not well understood. In this paper, the importance of considering patient heterogeneity for those who may be diagnosed with the same medical syndrome is discussed. The author suggests that the lack of satisfactory treatment outcomes for the treatments of chronic pain syndromes may be accounted for by the patient homogeneity myth--the assumption that all patients with the same medical diagnosis are similar on all important variables. The importance of subdividing (splitting) patients into meaningful groups is described. Studies presenting data on the identification of patient subgroups based on psychosocial and behavioral characteristics and the reliability and validity of this approach are presented. Some initial attempts to demonstrate the potential for matching treatments to patient subgroups are described.
大量不同的治疗方法已被证明对少数但在统计学上具有显著意义的不同慢性疼痛综合征患者有效，可减轻疼痛和其他症状。目前尚不清楚这些不同的治疗方法是通过何种方式取得相似疗效的。本文讨论了对于那些可能被诊断为相同医学综合征的患者而言，考虑患者异质性的重要性。作者认为，慢性疼痛综合征治疗缺乏令人满意的治疗效果，可能是由患者同质性误区导致的，即认为所有具有相同医学诊断的患者在所有重要变量上都是相似的。文中描述了将患者细分为有意义的组别的重要性。还介绍了一些基于社会心理和行为特征识别患者亚组的数据研究，以及这种方法的可靠性和有效性。文中还描述了一些初步尝试，以证明针对患者亚组匹配治疗方法的潜力。
