Reesor Kenneth A, Craig Kenneth D
Department of Psychology, The Rehabilitation Centre, Ottawa, Ont. K1H 8M2Canada Department of Psychology, University of British Columbia, Vancouver, BC V6T1Y7Canada.
Pain. 1988 Jan;32(1):35-45. doi: 10.1016/0304-3959(88)90021-8.
Chronic low back pain (CLBP) patients with pain and symptomatology incongruent with physical pathology have been found to have a poorer outcome to medical treatment and rehabilitation, and to use health care resources excessively. To examine possible psychological and behavioral bases for this pattern, this investigation contrasted 40 CLBP patients who displayed non-organic physical signs, inappropriate symptoms, and/or anatomically incongruent pain drawings with 40 'control' CLBP patients without incongruent pain criteria. Multivariate analyses revealed that the incongruent CLBP group reported greater pain intensity and depression, received higher observer ratings of pain, displayed more ambulatory/postural pain behavior, and reported more dysfunctional cognitions during pain. Incongruent CLBP patients also were found to have greater physical impairment and disability. When group differences on physical impairment/disability were controlled statistically, all the afore-mentioned differences disappeared, with one exception. Incongruent CLBP patients still displayed more maladaptive and dysfunctional cognitions. These findings indicate that incongruent CLBP patients may be conceptualized as ineffective and overwhelmed in their attempts to cope and as more physically disabled as a result of their pain. The role of cognitive factors, reasons for failure of physically based interventions, and implications for patient management are discussed.
已发现疼痛及症状与身体病理学不相符的慢性下腰痛（CLBP）患者药物治疗和康复效果较差，且过度使用医疗保健资源。为研究这种模式可能的心理和行为基础，本研究将40名表现出非器质性体征、不适当症状和/或解剖学上不相符疼痛绘图的CLBP患者与40名无疼痛不相符标准的“对照”CLBP患者进行了对比。多变量分析显示，疼痛不相符的CLBP组报告的疼痛强度和抑郁程度更高，观察者对其疼痛的评分更高，表现出更多的行走/姿势性疼痛行为，且在疼痛期间报告有更多功能失调的认知。还发现疼痛不相符的CLBP患者有更严重的身体损伤和残疾。当对身体损伤/残疾的组间差异进行统计学控制时，上述所有差异均消失，但有一个例外。疼痛不相符的CLBP患者仍表现出更多适应不良和功能失调的认知。这些发现表明，疼痛不相符的CLBP患者在应对疼痛时可能被认为是无效的且不堪重负，并且由于疼痛而身体残疾程度更高。本文讨论了认知因素的作用、基于身体的干预措施失败的原因以及对患者管理的影响。
