Jones Gareth T, Silman Alan J, Power Chris, Macfarlane Gary J
University of Aberdeen, Aberdeen, UK.
Arthritis Rheum. 2007 May;56(5):1669-75. doi: 10.1002/art.22587.
Studies have shown that common symptoms in childhood predict the onset of chronic widespread pain in the short term. However, it is unknown whether this association persists into adulthood. The aim of the current study was to examine, prospectively, whether children with common symptoms experience an increased risk of chronic widespread pain as adults.
Information on vomiting/bilious attacks, abdominal pain, and headaches/migraine was collected on 10,453 7-year-old children, by maternal report. Similar data were gathered when the children were ages 11 years and 16 years. Body pain at age 45 years was assessed by postal questionnaire. Poisson regression was used to examine chronic widespread pain in relation to childhood symptom reporting.
Of the 10,453 subjects on whom data were obtained when they were children, 7,470 participated at age 45 years (71.5%). Children with multiple symptoms at age 7 years experienced a 50% increased risk of chronic widespread pain (relative risk 1.5 [95% confidence interval 1.03, 2.3]). This relationship persisted after adjustment for sex, recent psychological distress, and childhood and current socioeconomic status, and after excluding children with major illnesses that might have explained early symptom reporting. A similar relationship with symptoms at ages 11 and 16 years was observed, although this was not associated with additional risk compared with that found with the presence of symptoms at age 7 years. However, despite a modest increase in risk, the presence of multiple symptoms at early ages was uncommon (<1.5%), and therefore, the associated population attributable risk was low (<1%).
Multiple common symptoms in childhood are associated with an increased risk of chronic widespread pain in adulthood. However, the magnitude of this increased risk is modest, and reports of multiple symptoms in childhood are uncommon. Thus the "early pain pathway" phenomenon is applicable only to a small proportion of individuals with chronic widespread pain.
研究表明，儿童期的常见症状可在短期内预测慢性广泛性疼痛的发作。然而，这种关联在成年后是否持续尚不清楚。本研究的目的是前瞻性地考察有常见症状的儿童成年后发生慢性广泛性疼痛的风险是否增加。
通过母亲报告收集了10453名7岁儿童有关呕吐/胆汁发作、腹痛和头痛/偏头痛的信息。在儿童11岁和16岁时收集了类似的数据。通过邮寄问卷评估45岁时的身体疼痛情况。采用泊松回归分析与儿童期症状报告相关的慢性广泛性疼痛。
在儿童期获得数据的10453名受试者中，7470人在45岁时参与了研究（71.5%）。7岁时有多种症状的儿童发生慢性广泛性疼痛的风险增加50%（相对风险1.5[95%置信区间1.03，2.3]）。在对性别、近期心理困扰、儿童期及当前社会经济状况进行调整后，以及排除可能解释早期症状报告的重大疾病儿童后，这种关系依然存在。观察到11岁和16岁时的症状与慢性广泛性疼痛也有类似关系，尽管与7岁时出现症状相比，这并未增加额外风险。然而，尽管风险有适度增加，但早年出现多种症状的情况并不常见（<1.5%），因此，相关的人群归因风险较低（<1%）。
儿童期的多种常见症状与成年后慢性广泛性疼痛风险增加有关。然而，这种风险增加的幅度较小，且儿童期出现多种症状的报告并不常见。因此，“早期疼痛途径”现象仅适用于一小部分慢性广泛性疼痛患者。
