Palmer K T, Calnan M, Wainwright D, O'Neill C, Winterbottom A, Watkins C, Poole J, Coggon D
MRC Environmental Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
Fam Pract. 2006 Dec;23(6):609-17. doi: 10.1093/fampra/cml047. Epub 2006 Oct 11.
Beliefs and mental well-being could influence decisions to consult about upper limb pain and satisfaction with care.
To describe beliefs about upper limb pain in the community and explore associations of beliefs and mental health with consulting and dissatisfaction.
Questionnaires were mailed to 4998 randomly chosen working-aged patients from general practices in Avon. We asked about upper limb pain, consulting, beliefs about symptoms, dissatisfaction with care, somatizing tendency (using elements of the Brief Symptom Inventory) and mental well-being (using the Short-Form 36). Associations were explored by logistic regression.
Among 2632 responders, 1271 reported arm pain during the past 12 months, including 389 consulters. A third or more of responders felt that arm pain sufferers should avoid physical activity, that problems would persist beyond 3 months, that a doctor should be seen straightaway and that neglect could lead to permanent harm. Consulters were significantly more likely to agree with these statements than other upper limb pain sufferers. The proportion of consultations attributable to such beliefs was substantial. Dissatisfaction with care was commoner in those with poor mental health: the OR for being dissatisfied (worst versus best third of the distribution) was 3.2 (95% CI 1.2-8.5) for somatizing tendency and 2.4 (95% CI 1.3-4.7) for SF-36 score. Both factors were associated with dissatisfaction about doctors' sympathy, communication and care in examining.
Negative beliefs about upper limb pain are common and associated with consulting. Somatizers and those in poorer mental health tend, subsequently, to feel dissatisfied with care.
信念和心理健康可能会影响上肢疼痛咨询的决策以及对治疗的满意度。
描述社区中关于上肢疼痛的信念，并探讨信念和心理健康与咨询及不满之间的关联。
向从埃文地区普通诊所随机选取的4998名工作年龄患者邮寄问卷。我们询问了上肢疼痛、咨询情况、对症状的信念、对治疗的不满、躯体化倾向（使用简明症状量表的部分内容）以及心理健康状况（使用简短健康调查问卷SF-36）。通过逻辑回归分析探讨关联。
在2632名回复者中，1271人报告在过去12个月中有手臂疼痛，其中389人进行了咨询。三分之一或更多的回复者认为手臂疼痛患者应避免体育活动，问题会持续超过3个月，应立即看医生，且忽视可能导致永久性伤害。与其他上肢疼痛患者相比，咨询者更有可能认同这些说法。因这些信念导致的咨询比例相当大。心理健康状况差的人对治疗的不满更为常见：躯体化倾向方面，不满的比值比（分布最差的三分之一与最好的三分之一相比）为3.2（95%置信区间1.2 - 8.5）；SF-36评分方面，比值比为2.4（95%置信区间1.3 - 4.7）。这两个因素都与对医生的同情、沟通以及检查过程中的治疗不满有关。
对上肢疼痛的消极信念很常见且与咨询有关。躯体化者和心理健康状况较差的人随后往往对治疗感到不满。
