Linton Steven James
Department of Behavioral, Social and Legal Sciences-Psychology, Orebro University, Orebro, Sweden.
Eur J Pain. 2005 Aug;9(4):355-61. doi: 10.1016/j.ejpain.2004.08.002.
This study aimed to conduct a comprehensive evaluation of background, individual and workplace psychological risk factors to investigated their relationship with spinal pain. Because there is some doubt as to whether the results of cross-sectional findings hold in longitudinal studies, a prospective study was superimposed upon a cross-sectional design of the effects of psychological variables on back pain and function to determine, whether similar results are obtained. Participants were workers randomly selected from the general population, where 372 had not experienced pain during the past year, and 209 had experienced considerable pain problems. A cross-sectional comparison of these groups using multivariate statistics indicated that the most potent risk factors were psychological distress (odds ratio=13.2) and poor function (odds ratio=6.4). Much smaller levels of risk were found for perceived workload, gender and foreign birth. Those participants with no pain were followed for one year to determine development of a spinal pain problem. Although few participants developed a significant pain problem, the prospective analyses showed that psychological distress (odds ratio=2.2), catastrophizing (odds ratio=3.0), and workload (odds ratio=2.3) produced the highest odds ratios. Taken together these results underscore the need for a multidimensional view of the development of pain disability. Moreover, individual psychological factors such as distress and catastrophizing as well as work place factors like work load were found to be highly related to the development of back pain in a sample of workers from the general population. The cross-sectional and prospective results were similar in character and demonstrate that cross-sectional studies may provide valuable information. Because psychological variables were relevant very early on, these factors may be important targets for pain prevention programs.
本研究旨在对背景、个体及工作场所心理风险因素进行全面评估，以调查它们与脊柱疼痛的关系。由于横断面研究结果在纵向研究中是否成立存在一些疑问，因此在心理变量对背痛和功能影响的横断面设计基础上叠加了一项前瞻性研究，以确定是否能获得相似结果。参与者是从普通人群中随机选取的工人，其中372人在过去一年中未经历过疼痛，209人有相当严重的疼痛问题。使用多变量统计对这些组进行横断面比较表明，最主要的风险因素是心理困扰（优势比=13.2）和功能不佳（优势比=6.4）。感知工作量、性别和外国出生的风险水平要低得多。对那些无疼痛的参与者随访一年，以确定脊柱疼痛问题的发展情况。尽管很少有参与者出现严重的疼痛问题，但前瞻性分析表明，心理困扰（优势比=2.2）、灾难化思维（优势比=3.0）和工作量（优势比=2.3）产生的优势比最高。综合这些结果强调了对疼痛残疾发展采取多维视角的必要性。此外，在来自普通人群的工人样本中，发现个体心理因素如困扰和灾难化思维以及工作场所因素如工作量与背痛的发展高度相关。横断面和前瞻性结果在性质上相似，表明横断面研究可能提供有价值的信息。由于心理变量在早期就具有相关性，这些因素可能是疼痛预防计划的重要目标。
