Koleck Michèle, Mazaux Jean-Michel, Rascle Nicole, Bruchon-Schweitzer Marilou
Psychology Unit EA 3662, University Victor Segalen, Bordeaux 2, France.
Eur J Pain. 2006 Jan;10(1):1-11. doi: 10.1016/j.ejpain.2005.01.003.
Low back pain (LBP) is a major problem of public health. Chronic pain is the most difficult to treat and the most expensive. The way patients cope with their pain may influence its outcome.
To identify coping strategies of LBP patients, and their influence on LBP evolution.
Ninety nine patients were assessed just after an acute LBP episode and one year later. Assessment tools included medical and social reports, scales of anxiety, depression, quality of life, locus of control (LOC), social support and coping strategies.
One year after the initial episode, 67% of patients have improved and 33% had a chronic pain. A principal components analysis showed that two main dimensions might be identified inside the outcome: functional and emotional non-adjustment. Functional non-adjustment was predicted by male gender, reduction of activity, and history of trauma over one year. Emotional non-adjustment was only predicted by trait-depression. Reactions to pain were structured in four factors: distraction-praying, helplessness-hopelessness, cognitive restructuration and perceived control. Two of these factors predicted adjustment one year later: distraction-praying had a direct effect on functional non-adjustment, and helplessness-hopelessness on emotional issue.
Besides somatic factors, psychosocial predictors of LBP chronic evolution may be identified. Both aspects must be taken into account in order to prevent chronic pain. Perhaps cognitive-behavior therapy may help LBP patients to cope with pain in a better way.
下背痛（LBP）是一个重大的公共卫生问题。慢性疼痛最难治疗且成本最高。患者应对疼痛的方式可能会影响其结果。
确定下背痛患者的应对策略及其对下背痛演变的影响。
对99例急性下背痛发作后及一年后的患者进行评估。评估工具包括医疗和社会报告、焦虑量表、抑郁量表、生活质量量表、控制点（LOC）、社会支持和应对策略。
初次发作一年后，67%的患者病情有所改善，33%患有慢性疼痛。主成分分析表明，在结果中可识别出两个主要维度：功能和情绪未调整。功能未调整由男性性别、活动减少和一年以上的创伤史预测。情绪未调整仅由特质抑郁预测。对疼痛的反应分为四个因素：分散注意力-祈祷、无助-绝望、认知重构和感知控制。其中两个因素可预测一年后的调整情况：分散注意力-祈祷对功能未调整有直接影响，无助-绝望对情绪问题有直接影响。
除了躯体因素外，还可识别出下背痛慢性演变的心理社会预测因素。为预防慢性疼痛，必须兼顾这两个方面。或许认知行为疗法可以帮助下背痛患者更好地应对疼痛。
