Connally Gena H, Sanders Steven H
Pain Control and Rehabilitation Institute of Georgia, Decatur, GA 30030 U.S.A.
Pain. 1991 Feb;44(2):139-146. doi: 10.1016/0304-3959(91)90127-J.
The current study examined the ability of overt pain behavior and cognitive coping strategies to predict low back pain patients' subsequent response to lumbar sympathetic nerve blocks and interdisciplinary pain rehabilitation. Seventeen chronic low back pain patients participated in the study. Each was assessed regarding pretreatment overt pain behavior, cognitive coping strategies and pretreatment outcome measures. They then received interdisciplinary pain rehabilitation including lumbar sympathetic blocks. Findings showed that patients exhibited significant improvement in posttreatment outcome measures and specific responses to nerve blocks. Regression analyses revealed that cognitive coping strategies failed to demonstrate any predictive utility across blocks or outcome measures. In contrast, overt pain behavior observed during the first block was highly predictive of acute and chronic subjective pain associated with initial and subsequent blocks, as well as posttreatment outcome measures for interdisciplinary pain rehabilitation. The more overt pain behavior observed during block 1, the more acute and chronic subjective pain observed across blocks and the poorer subsequent treatment outcome measures. This predictive capability was demonstrated over and above that of other pretreatment measures such as pain duration, number of surgeries, and receipt of economic compensation. Given the small sample size results were viewed with caution. It was concluded, however, that overt pain behavior might well be a significant predictor variable for specific and combined interdisciplinary pain rehabilitation techniques.
当前的研究考察了明显疼痛行为和认知应对策略预测腰痛患者随后对腰交感神经阻滞及多学科疼痛康复反应的能力。17名慢性腰痛患者参与了该研究。对每位患者的治疗前明显疼痛行为、认知应对策略及治疗前结果指标进行了评估。然后他们接受了包括腰交感神经阻滞在内的多学科疼痛康复治疗。研究结果显示，患者在治疗后结果指标方面有显著改善，且对神经阻滞有特定反应。回归分析表明，认知应对策略在各阻滞或结果指标中均未显示出任何预测效用。相比之下，在第一次阻滞期间观察到的明显疼痛行为高度预测了与初次及后续阻滞相关的急性和慢性主观疼痛，以及多学科疼痛康复的治疗后结果指标。在第一次阻滞期间观察到的明显疼痛行为越多，在各次阻滞中观察到的急性和慢性主观疼痛就越多，随后的治疗结果指标就越差。这种预测能力在疼痛持续时间、手术次数和获得经济补偿等其他治疗前指标之上得到了证明。鉴于样本量较小，对结果应谨慎看待。然而，可以得出结论，明显疼痛行为很可能是特定及联合多学科疼痛康复技术的一个重要预测变量。
