Institute for Community Medicine, University of Greifswald, Germany Institute of Social Medicine, University at Luebeck, Germany.
Pain. 2010 Apr;149(1):50-56. doi: 10.1016/j.pain.2010.01.025. Epub 2010 Feb 24.
Back pain severity has extensively been targeted in clinical and epidemiologic studies. However, despite the importance of a valid pain severity grading its adequate conceptualization in the general population has received comparatively little attention. The potentially misleading influence of measurement error remains unclear. Latent variable models allow for a versatile assessment of disease severity and will be applied to propose a model-based grading of back pain. This cross-sectional postal survey was carried out in Germany between 2003 and 2004 to address back pain severity in the general adult population. 8756 subjects, aged 18-75 years, provided data on measures of pain intensity and disability. Latent class analysis and confirmatory factor analysis were used to assess and compare categorical and dimensional representations of back pain severity. The results show that beyond differences in their location on a severity continuum, the subjects did not report markedly different pain intensity/disability profiles. Our analyses disconfirmed the presence of a sizeable high pain intensity, low disability subgroup. A comparison of the different latent variable models yielded a usable classification into five severity subtypes. This classification showed statistically significant and clinically important associations to health-related variables. Our results confirm the high burden of back pain in the general population but suggest a different categorization of those with severe back pain. This entails consequences on how to best target this important health problem from a public health perspective.
背痛严重程度已在临床和流行病学研究中广泛研究。然而，尽管有效的疼痛严重程度分级很重要，但在普通人群中，对其进行充分的概念化却相对较少关注。测量误差的潜在误导影响仍不清楚。潜在变量模型允许对疾病严重程度进行灵活评估，并将应用于提出基于模型的背痛分级。本横断面邮寄调查于 2003 年至 2004 年在德国进行，旨在评估普通成年人群中的背痛严重程度。8756 名年龄在 18-75 岁的受试者提供了疼痛强度和残疾程度的测量数据。潜在类别分析和验证性因子分析用于评估和比较背痛严重程度的分类和维度表示。结果表明，除了在严重程度连续体上的位置差异外，受试者并未报告明显不同的疼痛强度/残疾特征。我们的分析证实了存在相当数量的高疼痛强度、低残疾亚组。不同潜在变量模型的比较得出了可用于将严重程度分为五类的分类。这种分类与与健康相关的变量具有统计学显著和临床重要的关联。我们的结果证实了普通人群中背痛的高负担，但建议对严重背痛患者进行不同的分类。这对从公共卫生角度如何最好地针对这一重要健康问题产生了影响。
