Adams Heather, Ellis Tamra, Stanish William D, Sullivan Michael J L
University Centre for Research on Pain and Disability, 5595 Fenwick Street, Suite 314, Halifax, NS, Canada, B3H 4M2.
J Occup Rehabil. 2007 Jun;17(2):305-15. doi: 10.1007/s10926-007-9082-3. Epub 2007 May 8.
The present study examined the effects of pain chronicity on the responsiveness of psychosocial variables to intervention for whiplash injuries.
Participants (N = 75) were work disabled patients with a diagnosis of Whiplash Grade II and were clients in a 10-week community-based, psychosocial intervention aimed at facilitating return to work. Individuals were classified as subacute (4-12 weeks; N = 25), early chronic (3-6 months; N = 25), and chronic (6-18 months; N = 25). Patients in the three groups were matched on sex (13 men, 12 women) and age (+/-2 years). Patients completed measures of pain severity, self-reported disability, pain catastrophizing and fear of movement at pre-treatment, mid-treatment and post-treatment.
Return to work rates were 80, 72 and 32% for the subacute, early chronic and chronic groups, respectively. Individuals in the chronic group, compared to individuals in the subacute or early chronic groups, had significantly more elevated pre-treatment scores on measures of pain catastrophizing, F(2, 74) = 9.6, P < .001, and fear of movement, F(2, 74) = 3.4, P < .05. The magnitude of treatment-related reductions in catastrophizing, fear of movement and pain intensity was comparable across groups. However, individuals who were absent from work for more than 6 months showed the least amount of change in self-reported disability through the course of treatment.
The findings suggest that self-reported disability is particularly resistant to change as the period of work disability extends over time. The findings emphasize the importance of early intervention and the need to develop strategies that specifically target disability beliefs in patients with whiplash injuries.
本研究考察了疼痛慢性化对心理社会变量在鞭打损伤干预反应中的影响。
参与者（N = 75）为被诊断为二级鞭打损伤的工作致残患者，他们是一项为期10周的以社区为基础的心理社会干预的对象，该干预旨在促进重返工作岗位。个体被分为亚急性组（4 - 12周；N = 25）、早期慢性组（3 - 6个月；N = 25）和慢性组（6 - 18个月；N = 25）。三组患者在性别（13名男性，12名女性）和年龄（±2岁）上进行了匹配。患者在治疗前、治疗中期和治疗后完成了疼痛严重程度、自我报告的残疾程度、疼痛灾难化和运动恐惧的测量。
亚急性组、早期慢性组和慢性组的重返工作率分别为80%、72%和32%。与亚急性组或早期慢性组的个体相比，慢性组个体在疼痛灾难化测量（F(2, 74) = 9.6，P < .001）和运动恐惧测量（F(2, 74) = 3.4，P < .05）上的治疗前得分显著更高。三组中与治疗相关的灾难化、运动恐惧和疼痛强度降低的幅度相当。然而，缺勤超过6个月的个体在治疗过程中自我报告的残疾程度变化最小。
研究结果表明，随着工作残疾时间的延长，自我报告的残疾程度特别难以改变。这些发现强调了早期干预的重要性以及针对鞭打损伤患者的残疾信念制定具体策略的必要性。
