The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, Brisbane, Queensland, Australia University of South Australia, Sansom Institute for Health Research, Adelaide, South Australia, Australia Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand The University of Queensland, School of Nursing and Midwifery, Brisbane, Queensland, Australia Baker IDI Heart & Diabetes Institute, Preventative Cardiology Unit, Melbourne, Victoria, Australia.
Pain. 2011 Jul;152(7):1517-1524. doi: 10.1016/j.pain.2011.02.041. Epub 2011 May 12.
Sick leave due to low back pain (LBP-SL) is costly and compromises workforce productivity. The fear-avoidance model asserts that maladaptive pain-related cognitions lead to avoidance and disuse, which can perpetuate ongoing pain. Staying home from work is an avoidant behavior, and hence pain-related psychological features may help explain LBP-SL. We examined the relative contribution of pain catastrophizing, fear of movement, and pain coping (active and passive) in LBP-SL in addition to pain characteristics and other psychosocial, occupational, general health, and demographic factors. Two-way interactions between age and gender and candidate exposures were also considered. Our sample comprised 2164 working nurses and midwives with low back pain in the preceding year. Binary logistic regression was performed on cross-sectional data by manual backward stepwise elimination of nonsignificant terms to generate a parsimonious multivariable model. From an extensive array of exposures assessed, fear of movement (women, odds ratio [OR]=1.05, 95% confidence interval [CI] 1.02-1.08; men, OR=1.17, 95% CI 1.05-1.29), passive coping (OR=1.07, 95% CI 1.04-1.11), pain severity (OR=1.61, 95% CI 1.50-1.72), pain radiation (women, OR=1.45, 95% CI 1.10-1.92; men, OR=4.13, 95% CI 2.15-7.95), and manual handling frequency (OR=1.03, 95% CI 1.01-1.05) increased the likelihood of LBP-SL in the preceding 12 months. Administrators and managers were less likely to report LBP-SL (OR=0.44, 95% CI 0.27-0.71), and age had a protective effect in individuals in a married or de facto relationship (OR=0.97, 95% CI 0.95-0.98). In summary, fear of movement, passive coping, frequent manual handling, and severe or radiating pain increase the likelihood of LBP-SL. Gender-specific responses to pain radiation and fear of movement are evident.
因下背痛（LBP-SL）而请病假的成本很高，会影响劳动力的生产力。恐惧回避模型认为，适应不良的与疼痛相关的认知会导致回避和不用，从而使持续的疼痛持续存在。不上班是一种回避行为，因此与疼痛相关的心理特征可能有助于解释 LBP-SL。我们除了研究疼痛特征和其他心理社会、职业、一般健康和人口统计学因素外，还研究了疼痛灾难化、运动恐惧以及疼痛应对（主动和被动）在 LBP-SL 中的相对贡献。还考虑了年龄和性别与候选暴露之间的双向相互作用。我们的样本包括 2164 名在过去一年中有下背痛的在职护士和助产士。通过手动逐步向后消除无显著性的术语，对横断面数据进行二项逻辑回归，生成一个简洁的多变量模型。在评估的大量暴露因素中，运动恐惧（女性，比值比[OR]=1.05，95%置信区间[CI]1.02-1.08；男性，OR=1.17，95% CI 1.05-1.29）、被动应对（OR=1.07，95% CI 1.04-1.11）、疼痛严重程度（OR=1.61，95% CI 1.50-1.72）、疼痛辐射（女性，OR=1.45，95% CI 1.10-1.92；男性，OR=4.13，95% CI 2.15-7.95）和手动处理频率（OR=1.03，95% CI 1.01-1.05）增加了前 12 个月 LBP-SL 的可能性。管理员和经理报告 LBP-SL 的可能性较低（OR=0.44，95% CI 0.27-0.71），已婚或事实婚姻中的个体年龄具有保护作用（OR=0.97，95% CI 0.95-0.98）。总之，运动恐惧、被动应对、频繁的手动处理以及严重或辐射性疼痛会增加 LBP-SL 的可能性。对疼痛辐射和运动恐惧的性别特异性反应是明显的。
