Smart Keith M, Blake Catherine, Staines Anthony, Doody Catherine
St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Man Ther. 2012 Apr;17(2):119-25. doi: 10.1016/j.math.2011.10.002. Epub 2011 Nov 9.
Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of 'nociceptive' (NP), 'peripheral neuropathic' (PNP) and 'central sensitisation' (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain. This study employed a cross-sectional, between-subjects design. Four hundred and sixty-four patients with low back (±leg) pain were assessed using a standardised assessment protocol. Clinicians classified each patient's pain using a mechanisms-based classification approach. Patients completed a number of self-report measures associated with pain severity, health-related quality of life, functional disability, anxiety and depression. Discriminant validity was evaluated using a multivariate analysis of variance. There was a statistically significant difference between pain classifications on the combined self-report measures, (p = .001; Pillai's Trace = .33; partial eta squared = .16). Patients classified with CSP (n = 106) reported significantly more severe pain, poorer general health-related quality of life, and greater levels of back pain-related disability, depression and anxiety compared to those classified with PNP (n = 102) and NP (n = 256). A similar pattern was found in patients with PNP compared to NP. Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.
临床上需要有效性证据来支持基于机制的疼痛分类方法的应用。本研究的目的是通过评估以这种方式分类的患者在与疼痛各维度相关的健康指标上彼此之间的差异程度，来评价“伤害性”（NP）、“外周神经病理性”（PNP）和“中枢敏化”（CSP）作为腰痛（±腿痛）患者基于机制的疼痛分类的判别效度。本研究采用横断面、组间设计。使用标准化评估方案对464例腰痛（±腿痛）患者进行评估。临床医生采用基于机制的分类方法对每位患者的疼痛进行分类。患者完成了一些与疼痛严重程度、健康相关生活质量、功能障碍、焦虑和抑郁相关的自我报告测量。使用多变量方差分析评估判别效度。在综合自我报告测量中，疼痛分类之间存在统计学显著差异（p = .001； Pillai迹 = .33；偏 eta 平方 = .16）。与PNP组（n = 102）和NP组（n = 256）相比，CSP组（n = 106）的患者报告疼痛更严重、总体健康相关生活质量更差、背痛相关残疾、抑郁和焦虑水平更高。与NP组相比，PNP组患者也发现了类似的模式。基于机制的疼痛分类可能反映了疼痛多维性背后属性的有意义差异。需要进一步研究来评估基于机制的肌肉骨骼疼痛分类的结构效度和标准效度。
