Carroll Linda J, Cassidy J David, Côté Pierre
Department of Public Health Sciences, University of Alberta, Edmonton, Alta., Canada.
Pain. 2006 Sep;124(1-2):18-26. doi: 10.1016/j.pain.2006.03.012. Epub 2006 Apr 27.
Pain coping strategies are associated with pain severity, psychological distress and physical functioning in populations with persistent pain. However, there is little evidence regarding the relationship between coping styles and recovery from recent musculoskeletal injuries. We performed a large, population-based prospective cohort study of traffic injuries to assess the relationship between pain coping strategies and recovery from whiplash injuries. Subjects were initially assessed within 6 weeks of the injury, with structured telephone interview follow-up at 6 weeks, and 3, 6, 9 and 12 months post-injury. Coping was measured at 6 weeks using the Pain Management Inventory and recovery was assessed at each subsequent follow-up period, using a global self-report question. Multivariable Cox proportional hazards models showed that early use of passive coping strategies was independently associated with slower recovery. Depressive symptomatology (CES-D) was an effect modifier of this relationship. Without depressive symptomatology, those using high levels of passive coping recovered 37% slower than those using low levels of passive coping (HRR=0.63; 95% CI 0.44-0.91). However, in the presence of depressive symptomatology, those using high levels of passive coping recovered 75% more slowly than those who coped less passively (HRR=0.25; 95% CI 0.17-0.39). In other words, those with depressive symptoms but who used few passive coping strategies recovered four times more quickly than those with depressive symptoms who used high levels of passive coping. Active coping showed no independent association with recovery. These findings highlight the importance of early assessment of both coping behaviors and depressive symptomatology.
疼痛应对策略与慢性疼痛人群的疼痛严重程度、心理困扰及身体功能相关。然而，关于应对方式与近期肌肉骨骼损伤恢复之间的关系，证据很少。我们开展了一项基于人群的大型交通伤前瞻性队列研究，以评估疼痛应对策略与挥鞭样损伤恢复之间的关系。受试者在受伤后6周内接受初始评估，受伤后6周、3个月、6个月、9个月和12个月通过结构化电话访谈进行随访。在6周时使用疼痛管理量表测量应对情况，并在随后的每个随访期使用一个整体自我报告问题评估恢复情况。多变量Cox比例风险模型显示，早期使用被动应对策略与恢复较慢独立相关。抑郁症状（CES-D）是这种关系的效应修饰因素。在没有抑郁症状的情况下，使用高水平被动应对策略的人比使用低水平被动应对策略的人恢复慢37%（风险比=0.63；95%置信区间0.44-0.91）。然而，在有抑郁症状的情况下，使用高水平被动应对策略的人比被动应对较少的人恢复慢75%（风险比=0.25；95%置信区间0.17-0.39）。换句话说，有抑郁症状但很少使用被动应对策略的人比有抑郁症状且使用高水平被动应对策略的人恢复快四倍。主动应对与恢复无独立关联。这些发现凸显了早期评估应对行为和抑郁症状的重要性。
