Suzuki Shingo, Ohira Yoshiyuki, Noda Kazutaka, Ikusaka Masatomi
Department of General Medicine, Chiba University Hospital, Chiba, Japan.
J Pain Res. 2017 Jun 7;10:1411-1423. doi: 10.2147/JPR.S137482. eCollection 2017.
To develop a clinical score to discriminate patients with somatic symptom disorder (SSD) from those with medical disease (MD) for complaints of non-acute pain.
We retrospectively examined the clinical records of consecutive patients with pain for a duration of ≥1 month in our department from April 2003 to March 2015. We divided the subjects according to the diagnoses of definite SSD (as diagnosed and tracked by psychiatrists in our hospital), probable SSD (without evaluation by psychiatrists in our hospital), matched MD (randomly matched two patients by age, sex, and pain location for each definite SSD patient), unmatched MD, other mental disease, or functional somatic syndrome (FSS). We investigated eight clinical factors for definite SSD and matched MD, and developed a diagnostic score to identify SSD. We subsequently validated the model with cases of probable SSD and unmatched MD.
The number of patients with definite SSD, probable SSD, matched MD, unmatched MD, other mental disease, and FSS was 104 (3.5%), 214 (7.3%), 197 (6.7%), 742 (25%), 708 (24%), and 978 (33%), respectively. In a conditional logistic regression analysis, the following five factors were included as independent predictors of SSD: Analgesics ineffective, Mental disorder history, Unclear provocative/palliative factors, Persistence without cessation, and Stress feelings/episodes (A-MUPS). The area under the receiver operating characteristic curve (AUC) of the model was 0.900 (95% CI: 0.864-0.937, <0.001), and the McFadden's pseudo--squared was 0.709. For internal validation, the AUC between probable SSD and unmatched MD was 0.930 (95% CI: 0.910-0.950, <0.001). The prevalence and the likelihood ratio of SSD increased as the score increased.
The A-MUPS score was useful for discriminating patients with SSD from those with MD for complaints of non-acute pain, although external validation and refinement should be needed.
制定一种临床评分系统，以区分非急性疼痛主诉的躯体症状障碍（SSD）患者和患有内科疾病（MD）的患者。
我们回顾性研究了2003年4月至2015年3月期间在我科连续就诊的疼痛持续时间≥1个月的患者的临床记录。我们根据明确的SSD诊断（由我院精神科医生诊断并跟踪）、可能的SSD（未经我院精神科医生评估）、匹配的MD（为每个明确的SSD患者按年龄、性别和疼痛部位随机匹配两名患者）、不匹配的MD、其他精神疾病或功能性躯体综合征（FSS）对研究对象进行分组。我们调查了明确的SSD和匹配的MD的八个临床因素，并制定了一个诊断评分来识别SSD。随后，我们用可能的SSD和不匹配的MD病例对该模型进行了验证。
明确的SSD、可能的SSD、匹配的MD、不匹配的MD、其他精神疾病和FSS患者的数量分别为104例（3.5%）、214例（7.3%）、197例（6.7%）、742例（25%）、708例（24%）和978例（33%）。在条件逻辑回归分析中，以下五个因素被纳入作为SSD的独立预测因素：镇痛药无效、精神障碍病史、激发/缓解因素不明、持续不缓解以及应激感受/发作（A-MUPS）。该模型的受试者工作特征曲线下面积（AUC）为0.900（95%CI：0.864-0.937，<0.001），麦克法登伪R方为0.709。对于内部验证，可能的SSD和不匹配的MD之间的AUC为0.930（95%CI：0.910-0.950，<0.001）。SSD的患病率和似然比随着评分的增加而增加。
A-MUPS评分有助于区分非急性疼痛主诉的SSD患者和MD患者，尽管仍需要外部验证和完善。
