Waddell Gordon, Pilowsky Issy, Bond Michael R
West of Scotland Back Pain Research Unit, Western Infirmary, Glasgow, Scotland (U.K.) Dept. of Psychiatry, University of Adelaide, Adelaide, SAAustralia Psychological Medicine, University of Glasgow, Glasgow, Scotland (U.K.).
Pain. 1989 Oct;39(1):41-53. doi: 10.1016/0304-3959(89)90174-7.
Patients with chronic low back pain present with a mixture of symptoms and signs. Some are a direct consequence of physical pathology whereas others are attributable to associated and appropriate psychological and behavioural changes. At times the latter may be out of keeping with the degree of physical pathology and thus have specific significance in terms of the affective and cognitive disturbances that are also present and which may be the basis for abnormal illness behaviour. In an attempt to demonstrate more clearly the relationship between physical, psychological and behavioural components of illness, this paper draws on two data sets in patients with low back pain. The first explores the relationship between behavioural symptoms and signs, objective physical impairment, pain and disability and psychometric measures of distress together with scales making up the illness behaviour questionnaire (IBQ) of Pilowsky and Spence. A second data set is used to assess the value of the IBQ in understanding how psychological distress and behavioural signs and symptoms are related to the outcome of surgical treatment. The results gained reveal that behavioural symptoms and signs are directly related to the physical severity of low back disorder, the patient's report of pain and disability and the outcome of surgical treatment. Scores on the IBQ were strongly related to measures of affective disturbance and psychological distress. More specifically the disease affirmation scale of the IBQ, incorporating scales for disease conviction and psychological versus somatic focussing was an important dimension in relation to the behavioural symptoms and signs, thereby confirming results gained by other workers. Disease conviction and lack of response to clinicians' reassurances regarding illness - a situation in which abnormal illness behaviour is often deemed to exist - should not be seen simply as a function of the disease process, but more as a psychological coping mechanism for certain individuals under stress. The significance of this observation is discussed in relation to decisions regarding the overall assessment of chronic pain patients and their treatment.
慢性下腰痛患者会出现一系列症状和体征。有些是身体病理变化的直接后果，而另一些则归因于相关且适当的心理和行为改变。有时，后者可能与身体病理变化的程度不符，因此在情感和认知障碍方面具有特殊意义，而这些障碍也可能是异常疾病行为的基础。为了更清楚地说明疾病的身体、心理和行为成分之间的关系，本文借鉴了两组下腰痛患者的数据。第一组探讨了行为症状和体征、客观身体损伤、疼痛和残疾以及痛苦的心理测量指标与构成皮洛斯基和斯彭斯疾病行为问卷（IBQ）的量表之间的关系。第二组数据用于评估IBQ在理解心理痛苦以及行为症状和体征如何与手术治疗结果相关方面的价值。所得结果表明，行为症状和体征与下背部疾病的身体严重程度、患者报告的疼痛和残疾以及手术治疗结果直接相关。IBQ得分与情感障碍和心理痛苦的测量指标密切相关。更具体地说，IBQ的疾病确认量表，包括疾病信念量表以及心理与躯体关注量表，是与行为症状和体征相关的一个重要维度，从而证实了其他研究人员的结果。疾病信念以及对临床医生关于疾病的安慰缺乏反应——这种情况通常被认为存在异常疾病行为——不应仅仅被视为疾病过程的一种表现，而更应被看作是某些处于压力下的个体的一种心理应对机制。本文就慢性疼痛患者的全面评估及其治疗决策对这一观察结果的意义进行了讨论。
