McLaughlin J M, Witkop M L, Lambing A, Anderson T L, Munn J, Tortella B
Medicines Development Group, Pfizer Specialty Care, Collegeville, PA, USA.
Haemophilia. 2014 Jul;20(4):506-12. doi: 10.1111/hae.12360. Epub 2014 Feb 11.
Little data exist, especially for adolescent and young adult (AYA) persons with haemophilia (PWH), about the relationship between adherence to prescribed treatment regimen and chronic pain. We examined this relationship among PWH (moderate or severe) aged 13-25 via cross-sectional survey. Adherence was assessed using the Validated Hemophilia Regimen Treatment Adherence Scale (VERITAS)-Pro and VERITAS-PRN for prophylactic and on-demand participants respectively. VERITAS scores range from 24 (most adherent) to 120 (least adherent). Chronic pain was measured using the FPS-R and was dichotomized as high for FPS-R scores ≥4 and low for <4. Logistic regression models were constructed to assess factors associated with having high (vs. low) chronic pain. Of 80 AYA respondents (79 men), most had severe disease (91%), infused prophylactically (86%) and had haemophilia A (91%). Fifty-one per cent were aged 13-17 and most were white (76%), non-Hispanic (88%) and never married (93%). Chronic pain was reported as high for 35% of respondents. Mean VERITAS-Pro scores for those with high and low chronic pain were 53.6 ± 12.3 vs. 47.4 ± 12.9, P = 0.05. VERITAS-PRN scores were similar across chronic pain status. Logistic regression revealed that for each 10-point reduction (i.e. increase in adherence) in the combined VERITAS (Pro and PRN) and VERITAS-Pro scores there was a 35% (OR = 0.65; 95% CI = 0.44, 0.96; P = 0.03) and 39% (OR = 0.61; 95%CI = 0.39, 0.96; P = 0.03) reduction in odds of having high chronic pain respectively. Among AYA PWHs, better adherence was associated with significantly lower odds of having high chronic pain. Moreover, non-whites were >4 times as likely as whites to report high chronic pain.
关于血友病患者（PWH）坚持规定治疗方案与慢性疼痛之间的关系，现有数据很少，尤其是针对青少年和青年成人（AYA）血友病患者。我们通过横断面调查研究了13至25岁的中重度血友病患者（PWH）之间的这种关系。分别使用经过验证的血友病治疗方案依从性量表（VERITAS）-Pro和VERITAS-PRN对预防性和按需治疗的参与者进行依从性评估。VERITAS分数范围为24分（依从性最高）至120分（依从性最低）。使用面部疼痛量表修订版（FPS-R）测量慢性疼痛，并将其分为高分（FPS-R得分≥4）和低分（<4）两类。构建逻辑回归模型以评估与高（相对于低）慢性疼痛相关的因素。在80名AYA受访者（79名男性）中，大多数患有严重疾病（91%），采用预防性输注（86%），且患有A型血友病（91%）。51%的受访者年龄在13至17岁之间，大多数为白人（76%）、非西班牙裔（88%）且从未结婚（93%）。35%的受访者报告有高慢性疼痛。高慢性疼痛组和低慢性疼痛组的VERITAS-Pro平均得分分别为53.6±12.3和47.4±12.9，P = 0.05。VERITAS-PRN得分在慢性疼痛状态之间相似。逻辑回归显示，在综合VERITAS（Pro和PRN）和VERITAS-Pro得分中，每降低10分（即依从性增加），高慢性疼痛的几率分别降低35%（OR = 0.65；95%CI = 0.44，0.96；P = 0.03）和39%（OR = 0.61；95%CI = 0.39，0.96；P = 0.03）。在AYA PWH中，更好的依从性与高慢性疼痛的几率显著降低相关。此外，非白人报告高慢性疼痛的可能性是白人的4倍以上。
