Deyo R A, Bass J E, Walsh N E, Schoenfeld L S, Ramamurthy S
Multipurpose Arthritis Center, University of Texas Health Science Center, San Antonio 78284.
Arch Phys Med Rehabil. 1988 Mar;69(3 Pt 1):174-8.
Chronic pain patients share many characteristics, but there is important prognostic variability among them. By selecting for certain characteristics, different recruitment methods and entry criteria for clinical or research programs may influence the likelihood of success regardless of treatment efficacy. This was demonstrated when subjects (n = 55) were recruited through lay publicity for a clinical trial of therapy for chronic back pain. In comparison to routine pain clinic patients (n=61), subjects in the clinical trial were better educated, were more often employed, had more favorable personality profiles, and were less likely to have had surgery or narcotic use (all p less than 0.004). Pain relief was significantly better for clinical trial subjects, apparently due to baseline prognostic differences rather than uniquely efficacious therapy. We conclude that chronic pain patients vary in prognostically important ways; that recruitment methods and criteria strongly influence these characteristics; and that greater attention to these details is needed when interpreting and reporting clinical research.
慢性疼痛患者有许多共同特征，但他们之间存在重要的预后差异。通过选择某些特征，临床或研究项目的不同招募方法和入选标准可能会影响成功的可能性，而与治疗效果无关。这在一项针对慢性背痛治疗的临床试验中得到了证明，该试验通过大众宣传招募了55名受试者。与常规疼痛门诊患者（61名）相比，临床试验中的受试者受教育程度更高，就业比例更高，性格特征更有利，接受手术或使用麻醉剂的可能性更小（所有p值均小于0.004）。临床试验受试者的疼痛缓解明显更好，这显然是由于基线预后差异，而非独特有效的治疗方法。我们得出结论，慢性疼痛患者在预后的重要方面存在差异；招募方法和标准强烈影响这些特征；在解释和报告临床研究时，需要更加关注这些细节。
