Department of Physical Medicine and Rehabilitation, The Johns Hopkins School of Medicine, Phipps Rm 174, 600 N Wolfe St., Baltimore, MD 21287, USA Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Pain. 2011 Jun;152(6):1349-1357. doi: 10.1016/j.pain.2011.02.020. Epub 2011 Mar 10.
As part of a larger longitudinal study, the current analyses characterize the relationship among pain, psychological distress, and physical function after major lower extremity trauma. Structural equation modeling techniques were utilized to analyze data from a prospective 2-year observational study of 327 patients treated at 8 level I trauma centers. Data were gathered at 3, 6, 12, and 24 months after injury. In the models tested, higher levels of depressive and anxious distress at the preceding time point was related to lower levels of functioning at 6, 12, and 24 months, and higher levels of pain at the preceding time point were related to lower levels of functioning at 6 and 12 months, but not at 24 months. A reverse model in which lower levels of functioning led to higher levels of psychological distress or pain was tested and did not fit the data. The combination of depressive and anxious distress plays an increasingly important role in mediating the impact of pain on physical function as the recovery from lower extremity trauma progresses from early to later stages. Both pain and psychological distress contribute to reduced function during the first year after a serious injury; however, as recovery proceeds, the role of psychological distress in determining function increases. Longitudinal data on patients with severe leg trauma demonstrates that as recovery proceeds, psychological distress plays an increasingly important role in mediating the impact of pain on function.
作为一项更大规模纵向研究的一部分，本研究旨在分析下肢主要创伤后疼痛、心理困扰和身体功能之间的关系。采用结构方程建模技术对来自 8 个一级创伤中心的 327 例患者前瞻性 2 年观察性研究的数据进行分析。数据采集于损伤后 3、6、12 和 24 个月。在测试的模型中，前一时间点的抑郁和焦虑困扰程度越高，6、12 和 24 个月时的功能水平越低，前一时间点的疼痛程度越高，6 和 12 个月时的功能水平越低，但在 24 个月时则没有。还测试了一个反向模型，即较低的功能水平导致较高的心理困扰或疼痛水平，但该模型不符合数据。随着下肢创伤从早期向晚期恢复，抑郁和焦虑困扰的综合作用在疼痛对身体功能的影响中发挥着越来越重要的作用。疼痛和心理困扰都会导致严重损伤后第一年的功能下降；然而，随着恢复的进行，心理困扰在确定功能方面的作用增加。对严重腿部创伤患者的纵向数据表明，随着恢复的进行，心理困扰在疼痛对功能的影响中发挥着越来越重要的作用。
