Haukenes I, Hensing G, Stålnacke B M, Hammarström A
Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Department of Public Health and Clinical Medicine, Umeå University, Sweden.
Eur J Pain. 2015 Jul;19(6):826-33. doi: 10.1002/ejp.609. Epub 2014 Nov 4.
Studies have addressed the effect of multimodal pain rehabilitation (MMR), whereas criteria for selection are sparse. This study examines whether higher scores on musculoskeletal pain measures are associated with selection to MMR, and whether this differs across gender.
A clinical population of 262 male and 589 female patients was recruited consecutively during 3 years, 2007-2010. The patients were referred from primary care to a pain rehabilitation clinic in Northern Sweden for assessment and selection to MMR. Register-based data on self-reported pain were linked to patients' records where outcome (MMR or not) was stated. We modelled odds ratios for selection to MMR by higher scores on validated pain measures (pain severity, interference with daily life, pain sites and localized pain vs. varying pain location). Covariates were age, educational level and multiple pain measures. Anxiety and depression (Hospital, Anxiety and Depression Scale) and working status were used in sensitivity tests.
Higher scores of self-reported pain were not associated with selection to MMR in multivariate models. Among women, higher scores on pain severity, pain sites and varying pain location (localized pain = reference) were negatively associated with selection to MMR. After adjustment for multiple pain measures, the negative odds ratio for varying location persisted (OR = 0.59, 95% CI = 0.39-0.89).
Higher scores on self-reported pain did not guide selection to MMR and a negative trend was found among women. Studies of referral patterns and decision processes may contribute to a better understanding of the clinical practice that decides selection to MMR.
已有研究探讨了多模式疼痛康复（MMR）的效果，但选择标准却很稀少。本研究旨在检验肌肉骨骼疼痛测量得分较高是否与入选MMR相关，以及这种情况在不同性别之间是否存在差异。
在2007年至2010年的3年期间，连续招募了262名男性和589名女性患者的临床样本。这些患者从初级保健机构转诊至瑞典北部的一家疼痛康复诊所进行评估，以确定是否入选MMR。基于登记的自我报告疼痛数据与记录了结果（是否入选MMR）的患者记录相关联。我们通过验证性疼痛测量（疼痛严重程度、对日常生活的干扰、疼痛部位以及局限性疼痛与疼痛部位变化）的较高得分来模拟入选MMR的比值比。协变量包括年龄、教育水平和多种疼痛测量指标。在敏感性测试中使用了焦虑和抑郁（医院焦虑抑郁量表）以及工作状态。
在多变量模型中，自我报告疼痛的较高得分与入选MMR无关。在女性中，疼痛严重程度、疼痛部位和疼痛部位变化（以局限性疼痛为参照）的较高得分与入选MMR呈负相关。在对多种疼痛测量指标进行调整后，疼痛部位变化的负比值比仍然存在（比值比=0.59，95%置信区间=0.39-0.89）。
自我报告疼痛的较高得分不能指导MMR的选择，并且在女性中发现了一种负向趋势。对转诊模式和决策过程的研究可能有助于更好地理解决定MMR选择的临床实践。
