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在慢性颈部疼痛患者12个月随访时,疼痛敏感性测量指标与疼痛及残疾状况相关吗?

Are measures of pain sensitivity associated with pain and disability at 12-month follow up in chronic neck pain?

作者信息

Moloney Niamh, Beales Darren, Azoory Roxanne, Hübscher Markus, Waller Robert, Gibbons Rebekah, Rebbeck Trudy

机构信息

Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.

THRIVE Physiotherapy, Guernsey, Channel Islands.

出版信息

Musculoskeletal Care. 2018 Dec;16(4):415-424. doi: 10.1002/msc.1247. Epub 2018 Jun 14.

Abstract

OBJECTIVES

Pain sensitivity and psychosocial issues are prognostic of poor outcome in acute neck disorders. However, knowledge of associations between pain sensitivity and ongoing pain and disability in chronic neck pain are lacking. We aimed to investigate associations of pain sensitivity with pain and disability at the 12-month follow-up in people with chronic neck pain.

METHODS

The predictor variables were: clinical and quantitative sensory testing (cold, pressure); neural tissue sensitivity; neuropathic symptoms; comorbidities; sleep; psychological distress; pain catastrophizing; pain intensity (for the model explaining disability at 12 months only); and disability (for the model explaining pain at 12 months only). Data were analysed using uni- and multivariate regression models to assess associations with pain and disability at the 12-month follow-up (n = 64 at baseline, n = 51 at follow-up).

RESULTS

Univariable associations between all predictor variables and pain and disability were evident (r > 0.3; p < 0.05), except for cold and pressure pain thresholds and cold sensitivity. For disability at the 12-month follow-up, 24.0% of the variance was explained by psychological distress and comorbidities. For pain at 12 months, 39.8% of the variance was explained primarily by baseline disability.

CONCLUSIONS

Neither clinical nor quantitative measures of pain sensitivity were meaningfully associated with long-term patient-reported outcomes in people with chronic neck pain, limiting their clinical application in evaluating prognosis.

摘要

目的

疼痛敏感性和心理社会问题是急性颈部疾病预后不良的指标。然而,对于慢性颈部疼痛中疼痛敏感性与持续性疼痛及残疾之间的关联尚缺乏了解。我们旨在调查慢性颈部疼痛患者在12个月随访时疼痛敏感性与疼痛及残疾之间的关联。

方法

预测变量包括:临床和定量感觉测试(冷觉、压力觉);神经组织敏感性;神经病理性症状;合并症;睡眠;心理困扰;疼痛灾难化;疼痛强度(仅用于解释12个月时残疾情况的模型);以及残疾(仅用于解释12个月时疼痛情况的模型)。使用单变量和多变量回归模型分析数据,以评估与12个月随访时疼痛和残疾的关联(基线时n = 64,随访时n = 51)。

结果

除冷觉和压力觉疼痛阈值及冷觉敏感性外,所有预测变量与疼痛和残疾之间的单变量关联均显著(r > 0.3;p < 0.05)。对于12个月随访时的残疾情况,心理困扰和合并症解释了24.0%的方差。对于12个月时的疼痛情况,39.8%的方差主要由基线残疾情况解释。

结论

在慢性颈部疼痛患者中,无论是疼痛敏感性的临床测量还是定量测量,均与患者长期报告的结局无显著关联,限制了它们在评估预后方面的临床应用。

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