Psychology Department, The University of Alabama, Tuscaloosa, Alabama.
Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Pain Med. 2018 Dec 1;19(12):2387-2397. doi: 10.1093/pm/pny119.
Chronic pain is a serious health problem with high rates of health care utilization (HCU). Many patients become stymied in a perpetual cycle of unsuccessful attempts to find relief from suffering through frequent health care visits. Especially within low-income populations, the burdens of health care services are especially unpleasant due to significant financial costs, barriers to transportation, and high levels of stress. This study aimed to examine factors associated with HCU for chronic pain in low-income settings.
As part of the Learning About My Pain (LAMP) trial, a randomized comparative effectiveness study of group-based psychosocial interventions (PCORI Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in Alabama, medical records one-year prior to randomization were retrospectively collected for data analysis. HCU was defined as the sum of health care visits for chronic pain over this one-year period. Sociodemographic traits (age, sex, race, poverty status, primary literacy, education level), pain related variables (pain severity, pain interference, disability, number of pain sites, number of pain types, opioid prescriptions), and psychological variables (depressive symptoms, pain catastrophizing) were entered into a hierarchical multiple regression model to predict HCU.
Results suggested that race/ethnicity, having received an opioid prescription in the year prior to treatment onset, and higher depressive symptoms were associated with increased HCU for chronic pain conditions.
Depressive symptoms are an essential aspect of increased health care use. Study findings support the need for a biopsychosocial approach to chronic pain management.
慢性疼痛是一个严重的健康问题，其医疗保健利用率（HCU）很高。许多患者在频繁就医以试图缓解痛苦的过程中陷入了无休止的失败循环。特别是在低收入人群中，由于医疗服务费用高昂、交通障碍以及高度的压力，卫生保健服务的负担尤其令人不快。本研究旨在探讨低收入环境中与慢性疼痛 HCU 相关的因素。
作为基于小组的心理社会干预（PCORI 合同#941，Beverly Thorn，PI；clinicaltrials.gov 标识符 NCT01967342）的一项随机对照有效性研究的一部分，该研究针对在阿拉巴马州低收入诊所接受慢性疼痛治疗的患者，回顾性收集了随机分组前一年的医疗记录进行数据分析。HCU 被定义为这一年内治疗慢性疼痛的就诊次数总和。社会人口特征（年龄、性别、种族、贫困状况、主要读写能力、教育水平）、疼痛相关变量（疼痛严重程度、疼痛干扰、残疾、疼痛部位数、疼痛类型数、阿片类药物处方）和心理变量（抑郁症状、疼痛灾难化）被纳入层次多重回归模型，以预测 HCU。
结果表明，种族/民族、在治疗开始前一年接受过阿片类药物处方以及更高的抑郁症状与慢性疼痛状况的 HCU 增加有关。
抑郁症状是增加医疗保健使用的重要方面。研究结果支持对慢性疼痛管理采用生物心理社会方法的必要性。
