Jöud Anna, Björk Jonas, Gerdle Björn, Grimby-Ekman Anna, Larsson Britt
Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden.
Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden.
Scand J Pain. 2017 Jul;16:122-128. doi: 10.1016/j.sjpain.2017.04.071. Epub 2017 May 25.
Pain is common and adds to the global burden of disease. However, individuals suffering from pain are a heterogeneous group in terms of pain spreading, intensity and duration. While pain influences overall health care consultation not everyone with pain consult health care. To be able to provide health care matching the patients' needs increased knowledge about what factors determines the decision to consult health care is essential. The aim of this study was to explore the combined importance of pain spreading, intensity, duration and pain catastrophizing for consulting health care.
In this cross-sectional study we used population based survey data from southeast Sweden (SWEPAIN) including 7792 individuals' aged 16-85 reporting pain. We used Modified Poisson regressions to analyse factors of importance related to the decision to consult health care.
High and moderate pain intensity, as compared to low, increases the probability of consulting health care (High PR=1.7 [95% CI 1.51-1.88], moderate PR=1.2 [1.15-1.41]). Having widespread pain, as compared to localised pain, increased the probability of consulting health (PR=1.2 [1.03-1.36). Pain duration was not associated with increased probability of consulting health care (PR=1.0 CI0.88-1.07). However an interaction (p=0.05) between pain duration and pain catastrophizing beliefs was seen indicating a combined importance of the two when consulting health care.
Our result suggests that pain intensity, pain spreading and pain catastrophizing independently influence the decision to consult health care while there is an interaction effect between pain duration and pain catastrophizing beliefs where the importance of pain catastrophizing believes differ with pain duration; the importance of pain catastrophizing believes differ with pain duration.
Treatment and rehabilitation strategies should incorporate this finding in order to meet the individual's needs focusing on the biopsychosocial model within health care focusing not only on actual pain reliefs but also on for example acceptance and behavioural changes.
疼痛很常见，且加重了全球疾病负担。然而，疼痛患者在疼痛扩散、强度和持续时间方面是一个异质性群体。虽然疼痛会影响整体医疗咨询，但并非所有疼痛患者都会咨询医疗服务。为了能够提供符合患者需求的医疗服务，增加对决定咨询医疗服务的因素的了解至关重要。本研究的目的是探讨疼痛扩散、强度、持续时间和疼痛灾难化对咨询医疗服务的综合重要性。
在这项横断面研究中，我们使用了瑞典东南部基于人群的调查数据（SWEPAIN），其中包括7792名年龄在16 - 85岁之间报告有疼痛的个体。我们使用修正泊松回归分析与咨询医疗服务决定相关的重要因素。
与轻度疼痛相比，中度和重度疼痛会增加咨询医疗服务的概率（重度PR = 1.7 [95% CI 1.51 - 1.88]，中度PR = 1.2 [1.15 - 1.41]）。与局部疼痛相比，广泛性疼痛会增加咨询医疗服务的概率（PR = 1.2 [1.03 - 1.36]）。疼痛持续时间与咨询医疗服务概率的增加无关（PR = 1.0 [0.88 - 1.07]）。然而，观察到疼痛持续时间与疼痛灾难化信念之间存在相互作用（p = 0.05），表明在咨询医疗服务时两者具有综合重要性。
我们的结果表明，疼痛强度、疼痛扩散和疼痛灾难化独立影响咨询医疗服务的决定，而疼痛持续时间与疼痛灾难化信念之间存在相互作用，其中疼痛灾难化信念的重要性因疼痛持续时间而异；疼痛灾难化信念的重要性因疼痛持续时间而异。
治疗和康复策略应纳入这一发现，以便在医疗保健中以生物心理社会模型为重点满足个体需求，不仅关注实际的疼痛缓解，还关注例如接受度和行为改变。
