Arthritis Research UK Primary Care Centre, Keele University, Cherterfield, UK.
Clin J Pain. 2013 May;29(5):411-6. doi: 10.1097/AJP.0b013e318257099e.
To test whether the prognostic definition of chronic pain, which has previously been applied in specific anatomic areas, performed well in a cohort of older adults with a range of musculoskeletal pain sites.
Data are taken from the Prognostic Research Study of adults aged 50 years and above consulting their general practitioner with any musculoskeletal pain, who completed postal surveys immediately after consultation and 12 months later. Baseline risk of clinically significant pain persisting at 12 months' follow-up, defined as a Chronic Pain Grade ≥II, was calculated using the prognostic approach, which includes a range of pain and related factors. The approach was implemented using logistic regression models, and the performance of the approach, including cutoffs in the score to define groups with differing levels of risk, was assessed in terms of calibration and discrimination.
Application of the original risk cutoffs created groups with increasing proportions of chronic pain (area under the curve =0.79). However, the probability of chronic pain in each group was higher than expected by the model. New cutoffs were defined for this group of older adults: score ≤5=probability of chronic pain <20%, ≤11=probability <50%, ≤16=probability <80%, which resulted in good calibration of the model.
The prognostic approach to defining chronic pain is suitable for use in older adults consulting primary care with musculoskeletal pain at a range of sites, but new cutoffs are needed to allow for the higher risk profile in this group. An adapted version of this method may also have the potential for application directly within the clinical consultation.
检验先前在特定解剖区域应用的慢性疼痛预后定义在患有多种肌肉骨骼疼痛部位的老年患者人群中表现是否良好。
数据来自于一项预后研究，研究对象为 50 岁及以上、因任何肌肉骨骼疼痛就诊于全科医生的成年人，他们在就诊后立即和 12 个月后通过邮寄调查完成随访。使用预后方法计算基线时 12 个月随访时出现持续的临床显著疼痛（慢性疼痛等级≥Ⅱ）的风险，该方法包括一系列疼痛和相关因素。使用逻辑回归模型实施该方法，并根据校准和区分评估方法的性能，包括评分中的截断值，以定义具有不同风险水平的组。
应用原始风险截断值可创建慢性疼痛比例逐渐增加的组（曲线下面积=0.79）。然而，每个组中慢性疼痛的概率均高于模型预测。为这群老年人定义了新的截断值：评分≤5=慢性疼痛的概率<20%，≤11=慢性疼痛的概率<50%，≤16=慢性疼痛的概率<80%，这使得模型的校准效果良好。
用于定义慢性疼痛的预后方法适用于在多种部位出现肌肉骨骼疼痛就诊于初级保健的老年人，但该组风险较高，需要新的截断值。该方法的改编版本也有可能直接在临床咨询中应用。
