Mason Victoria L, Mathias Beth, Skevington Suzanne M
WHO Centre for the Study of Quality of Life, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
Clin J Pain. 2008 Jan;24(1):22-9. doi: 10.1097/AJP.0b013e318156d94f.
Whether individuals with chronic low back pain (CLBP) are willing to accept their pain, is of interest to pain management, but how far is the acceptance of pain related to a good quality of life (QoL)? Recently available measures now enable this question to be investigated; these are (1) the Chronic Pain Acceptance Questionnaire (CPAQ) and a revised version, here described as a short-form (SF-CPAQ), and (2) the World Health Organization Quality of Life Assessment (WHOQOL)-Pain, which is composed of the generic WHOQOL-100 profile (25 facets in 6 domains), and 4 additional facets within a specific pain and discomfort module (PDM).
Eighty-six CLBP outpatients (62.8% female, mean age 54.3 y, mean pain duration 69.4 mo) completed the CPAQ and WHOQOL-Pain, mailed 2 weeks before a pain clinic appointment.
General QoL was positively associated with overall acceptance of pain (CPAQ: r=0.376, P=0.003; SF-CPAQ: r=0.582, P<0.001), and with activity engagement (r=0.455, P<0.001) and pain willingness (r=0.493, P<0.001) specifically. Lower reports of pain were also associated with a better QoL (r=-0.349, P=0.002). Pain level was important in explaining QoL relating to the physical and social domains and pain-related facets assessed by the PDM. Overall, acceptance contributed to explain QoL in the level of independence and environment domains and for pain-related QoL assessed by the PDM. However, pain and acceptance only made a modest contribution to explaining psychologic and social dimensions of QoL.
The results indicate that present pain level and whether or not pain is accepted play an important role in the QoL of patients with chronic pain. Additionally, the results provide construct validity for the WHOQOL-Pain and SF-CPAQ measures, especially dimensions of pain willingness and activities engagement. The findings have implications for the way health care is delivered, particularly for the role of acceptance-based treatments for individuals with CLBP.
慢性下腰痛（CLBP）患者是否愿意接受自身疼痛，这是疼痛管理领域所关注的问题，但疼痛接受程度与良好生活质量（QoL）之间的关联程度如何？近期可用的测量方法使得这个问题能够得到研究；这些方法包括：（1）慢性疼痛接受问卷（CPAQ）及其修订版，此处称为简版（SF-CPAQ）；（2）世界卫生组织生活质量评估（WHOQOL）-疼痛量表，它由通用的WHOQOL-100量表（6个领域中的25个方面）以及特定疼痛与不适模块（PDM）中的4个附加方面组成。
86名CLBP门诊患者（女性占62.8%，平均年龄54.3岁，平均疼痛持续时间69.4个月）在疼痛门诊预约前2周通过邮寄方式完成了CPAQ和WHOQOL-疼痛量表。
总体生活质量与对疼痛的总体接受程度呈正相关（CPAQ：r = 0.376，P = 0.003；SF-CPAQ：r = 0.582，P < 0.001），尤其与活动参与度（r = 0.455，P < 0.001）和疼痛意愿（r = 0.493，P < 0.001）呈正相关。疼痛报告较低也与较好的生活质量相关（r = -0.349，P = 0.002）。疼痛水平在解释与身体和社会领域以及PDM评估的与疼痛相关方面有关的生活质量方面很重要。总体而言，接受程度有助于解释在独立和环境领域的生活质量以及PDM评估的与疼痛相关的生活质量。然而，疼痛和接受程度在解释生活质量的心理和社会维度方面仅起适度作用。
结果表明，当前的疼痛水平以及是否接受疼痛在慢性疼痛患者的生活质量中起着重要作用。此外，结果为WHOQOL-疼痛量表和SF-CPAQ测量方法提供了结构效度，特别是疼痛意愿和活动参与度维度。这些发现对医疗保健的提供方式具有启示意义，特别是对于基于接受的治疗方法在CLBP患者中的作用。
