Christensen Jan Olav, Johansen Sissel, Knardahl Stein
Department of Work Psychology and Physiology, The National Institute of Occupational Health, Oslo, Norway.
Oslo and Akershus University College of Applied Sciences, Faculty of Social Sciences, Department of Social Work, Child Welfare and Social Policy, Oslo, Norway.
BMC Musculoskelet Disord. 2017 Apr 4;18(1):140. doi: 10.1186/s12891-017-1503-7.
The pathogenesis of syndromes of widespread musculoskeletal pain remains an enigma. The present study sought to determine if psychological states, job satisfaction, pain intensity, and sleep problems contributed to the spread and decline of the number of musculoskeletal pains.
A sample of 2989 Norwegian employees completed a questionnaire at baseline and follow-up 2 years later. Data were analyzed with multinomial and ordinal logistic regression analyses to determine effects on direction and degree of change of number of pain sites (NPS).
After adjustment for sex, age, skill level, and number of pain sites at baseline, increases in the number of pain sites from baseline to follow-up were predicted by emotional exhaustion, mental distress, having little surplus, feeling down and sad, sleep disturbances, and intensity of headache. Decreases were predicted by low levels of emotional exhaustion, mental distress, sleep disturbances, restlessness, and lower intensity of headache, neck pain, shoulder pain, and back pain. Higher numbers of pain sites at baseline were associated with reduction of number of pain sites and lower likelihood of spread. Some factors that did not predict whether decrease or increase occurred were nevertheless associated with the degree of decrease (depression, anxiety, having surplus, self-efficacy) or increase (anxiety).
Several psychological and physiological factors predicted change in the number of pain sites. There is a need for further investigations to identify possible mechanisms by which psychological and behavioral factors propagate the spread of pain.
广泛肌肉骨骼疼痛综合征的发病机制仍是一个谜。本研究旨在确定心理状态、工作满意度、疼痛强度和睡眠问题是否会导致肌肉骨骼疼痛数量的增加和减少。
2989名挪威员工的样本在基线时完成了一份问卷，并在两年后的随访中再次填写。使用多项和有序逻辑回归分析对数据进行分析，以确定对疼痛部位数量（NPS）变化方向和程度的影响。
在对性别、年龄、技能水平和基线时的疼痛部位数量进行调整后，从基线到随访期间疼痛部位数量的增加可由情绪耗竭、精神痛苦、几乎没有盈余、情绪低落和悲伤、睡眠障碍以及头痛强度来预测。疼痛部位数量的减少可由低水平的情绪耗竭、精神痛苦、睡眠障碍、烦躁不安以及较低强度的头痛、颈部疼痛、肩部疼痛和背部疼痛来预测。基线时疼痛部位数量较多与疼痛部位数量的减少和扩散可能性较低相关。一些无法预测疼痛部位数量是减少还是增加的因素，仍然与减少程度（抑郁、焦虑、有盈余、自我效能感）或增加程度（焦虑）相关。
几种心理和生理因素可预测疼痛部位数量的变化。有必要进一步研究，以确定心理和行为因素促使疼痛扩散的可能机制。
