Pincus Tamar, Vogel Steven, Burton A Kim, Santos Rita, Field Andy P
Department of Psychology, Royal Holloway, University of London, Egham, UK.
Arthritis Rheum. 2006 Dec;54(12):3999-4010. doi: 10.1002/art.22273.
Fear of pain, which is hypothesized to result in avoidance behavior, has been described as an obstacle to recovery in populations of patients with low back pain. However, the evidence to support the link between high levels of fear at early stages of pain and poor prognosis has yet to be systematically assessed. We undertook this review to explore current evidence and to propose further development of theoretical models.
We performed a systematic literature review of all prospective inception cohorts of patients with acute low back pain that measured fear of pain (often described as fear avoidance) at baseline.
We reviewed 9 studies reported between 2001 and 2006. Several of these had acceptable/good methodology. Three studies, of which at least 1 had excellent methodology, showed no link between measures of fear at baseline and poor prognosis in the short term (3 months) or the long term (12 months). Three studies with acceptable methodology showed weak evidence for such a link, but the effect sizes were small. The only study with acceptable methodology to find a clear link suggested that fear of movement was linked to long-term pain.
Despite the prevalent focus on fear of pain at early stages of back pain, there is little evidence to link such fear states with poor prognosis. There is some evidence to suggest that fear may play a role when pain has become persistent. There is a growing consensus that distress/depression plays an important role at early stages, and clinicians should focus on these factors.
疼痛恐惧被认为会导致回避行为，在腰痛患者群体中，它被描述为康复的障碍。然而，支持疼痛早期阶段的高度恐惧与预后不良之间联系的证据尚未得到系统评估。我们进行这项综述以探索现有证据并提出理论模型的进一步发展。
我们对所有测量基线疼痛恐惧（通常称为恐惧回避）的急性腰痛患者前瞻性起始队列进行了系统文献综述。
我们回顾了2001年至2006年间报告的9项研究。其中几项研究方法可接受/良好。三项研究（其中至少1项研究方法优秀）表明，基线恐惧测量与短期（3个月）或长期（12个月）预后不良之间没有联系。三项方法可接受的研究显示出这种联系的证据较弱，但效应量较小。唯一一项方法可接受且发现明确联系的研究表明，运动恐惧与长期疼痛有关。
尽管在背痛早期普遍关注疼痛恐惧，但几乎没有证据表明这种恐惧状态与预后不良有关。有一些证据表明，当疼痛持续时，恐惧可能起作用。越来越多的共识是，痛苦/抑郁在早期阶段起重要作用，临床医生应关注这些因素。
