患有广泛性疼痛的移民患者。瑞典初级医疗保健中医师的临床发现。

The immigrant patient having widespread pain. Clinical findings by physicians in Swedish primary care.

作者信息

Löfvander Monica B, Engström Alf W

机构信息

Center for Family Medicine, Department of Clinical Sciences, Karolinska Institutet, Huddinge, Sweden.

出版信息

Disabil Rehabil. 2007 Mar 15;29(5):381-8. doi: 10.1080/09638280600835325.

DOI:10.1080/09638280600835325

PMID:17364790

Abstract

AIM

Do the clinical findings explain the complaints of longstanding demonstrated widespread pain (DWP) in a group of immigrant patients, or not?

SUBJECTS

Consecutive immigrant patients, on long-term sick leave, aged 18 - 45, at a primary healthcare centre in Stockholm, Sweden.

METHODS

Interpreters were available. Two primary care physicians jointly, made a somatic status and diagnosed tender-structure locations (> or =3 tender-structure locations or less) and depression (yes or no), and assessed psychosocial stressors (little or much) and pain-related anxiety (yes or no). The patients pointed at their pain parts. This was transferred by one of the doctors to a pain drawing with 18 fields. Five or more fields were defined as DWP. Non-parametric tests were used to detect significant differences between the DWP and non-DWP groups. Cumulative frequencies of the following four categories of explanatory variables of DWP were counted: > or =3 tender-structure locations (could also include the other variables), much psychosocial stress (could include depression and pain-related anxiety), depression (could include pain-related anxiety), or pain-related anxiety alone.

RESULTS

Many of the 49 men and 100 women, on average 38 years, spoke little or no Swedish. A fifth of the men (n = 10) and half (n = 56) of the women had DWP. These men often had much stress (p < 0.01) while the women had > or =3 tender-structure locations (p < 0.001). DWP among men was explained to 100% by: > or =3 tender-structure locations (30%), much psychosocial stress (60%), or depression alone (10%). DWP among the women was explained to 96 cum. % by: > or =3 tender-structure locations (59%), much psychosocial stress (25%), or pain-related anxiety alone (13%).

CONCLUSION

Demonstrated widespread pain was nearly always explained by clinical findings, and especially by numerous tender-structure locations in women. There is a need for more studies among men.

摘要

目的

在一组移民患者中，临床检查结果能否解释长期存在的广泛性疼痛（DWP）主诉？

研究对象

瑞典斯德哥尔摩一家初级医疗中心连续就诊的、正在休长期病假、年龄在18至45岁的移民患者。

方法

有口译人员协助。两名初级保健医生共同进行躯体状况检查，诊断压痛结构部位（≥3个或少于3个压痛结构部位）和抑郁情况（是或否），评估心理社会应激源（少或多）以及与疼痛相关的焦虑（是或否）。患者指出自己疼痛的部位，由一名医生将其标注在有18个区域的疼痛图上。5个或更多区域被定义为广泛性疼痛。采用非参数检验来检测广泛性疼痛组和非广泛性疼痛组之间的显著差异。统计以下四类DWP解释变量的累积频率：≥3个压痛结构部位（也可能包括其他变量）、心理社会应激多（可能包括抑郁和与疼痛相关的焦虑）、抑郁（可能包括与疼痛相关的焦虑）或仅与疼痛相关的焦虑。

结果

49名男性和100名女性，平均年龄38岁，其中许多人几乎不会说瑞典语或根本不会说瑞典语。五分之一的男性（n = 10）和一半的女性（n = 56）有广泛性疼痛。这些男性常有较多应激（p < 0.01），而女性有≥3个压痛结构部位（p < 0.001）。男性的广泛性疼痛100%可由以下因素解释：≥3个压痛结构部位（30%）、心理社会应激多（60%）或仅抑郁（10%）。女性的广泛性疼痛96%累积可由以下因素解释：≥3个压痛结构部位（59%）、心理社会应激多（25%）或仅与疼痛相关的焦虑（13%）。