Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
National Competence Centre for Complex Symptom Disorders, St. Olav's Hospital, University Hospital of Trondheim, Norway.
Eur J Pain. 2018 Oct;22(9):1606-1616. doi: 10.1002/ejp.1243. Epub 2018 May 29.
Epidemiological studies of chronic pain frequently report high prevalence estimates. However, there is little information about the development and natural course of chronic pain.
We followed a random sample of participants from a population-based study (HUNT 3) with annual measures over 4 years.
Among those without chronic pain at baseline, the probability of developing moderate to severe chronic pain (cumulative incidence) during the first year was 5%, a pain status that was maintained among 38% at the second follow-up. The probability of developing chronic pain diminished substantially for those who maintained a status of no chronic pain over several years. Subjects with moderate to severe chronic pain at baseline had an 8% probability of recovery into no chronic pain, a status that was maintained for 52% on the second follow-up. The probability of recovery diminished substantially as a status of chronic pain was prolonged for several years. Pain severity, widespread pain, pain catastrophizing, depression and sleep were significant predictors of future moderate to severe chronic pain, both among subjects with and without chronic pain at baseline.
These findings suggest that the prognosis is fairly good after a new onset of chronic pain. When the pain has lasted for several years, the prognosis becomes poor. The same social and psychological factors predict new onset and the prognosis of chronic pain.
The development and recovery of chronic pain is highly dependent on previous pain. The prognosis of chronic pain may be predicted well when considering its duration in combination with other clinical, social and psychological factors. Targeting modifiable prognostic factors may be particularly important for newly developed chronic pain.
慢性疼痛的流行病学研究经常报告高患病率估计。然而，关于慢性疼痛的发展和自然病程的信息很少。
我们对一项基于人群的研究（HUNT3）的随机样本参与者进行了随访，每年随访 4 年。
在基线时没有慢性疼痛的人群中，第一年发展为中重度慢性疼痛（累积发病率）的概率为 5%，在第二次随访时有 38%的人保持这种疼痛状态。对于那些在几年内保持无慢性疼痛状态的人来说，发展为慢性疼痛的概率大大降低。基线时有中重度慢性疼痛的受试者有 8%的可能性恢复为无慢性疼痛，在第二次随访时有 52%的人保持这种状态。随着慢性疼痛持续数年，恢复的可能性大大降低。疼痛严重程度、广泛疼痛、疼痛灾难化、抑郁和睡眠是未来中重度慢性疼痛的重要预测因素，无论是在基线时有还是没有慢性疼痛的受试者中都是如此。
这些发现表明，新发慢性疼痛后的预后相当好。当疼痛持续数年时，预后就会变得很差。相同的社会和心理因素预测慢性疼痛的新发和预后。
慢性疼痛的发展和恢复高度依赖于先前的疼痛。当考虑疼痛的持续时间以及其他临床、社会和心理因素时，慢性疼痛的预后可以很好地预测。针对可改变的预后因素可能对新发生的慢性疼痛尤为重要。
