Peilot Birgitta, Andréll Paulin, Gottfries Johan, Sundler Annelie J, Mannheimer Clas
Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Chemistry and Molecular Biology, Gothenburg University, Sweden.
Pain Res Treat. 2018 Dec 2;2018:9451313. doi: 10.1155/2018/9451313. eCollection 2018.
The aim of this pilot study was to describe vulnerability and resilience and possible subgroups in patients with chronic work related musculoskeletal pain in occupational healthcare. A second aim was to evaluate a patient-centered approach.
This study was based on consecutive patients with chronic pain, seen by the same physician and sick-listed full or part time three months or longer. They were included during a period of three months. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8 months. A patient-centered approach was applied where the patient's whole situation was taken into account.
A dominance of an insecure dismissing attachment pattern and a subnormal sense of coherence (SOC) was reported both at baseline and at follow-up. The patients (n=38) reported significant improvement of pain severity (=0.01), pain interference (=0.001), life control (=0.01), affective distress (=0.02), and dysfunction (=0.001) on the multidimensional pain inventory (MPI) and fewer patients were sick-listed full time at follow-up (13 patients versus 21). By means of multivariate data analyses this change in MPI was confirmed and was also correlated with a significant increase in health related quality of life (HRQoL). Moreover subgroups with different outcome at follow-up were identified according to attachment pattern and subgroups on MPI.
A patient-centered approach may be of value for patients with chronic pain in occupational healthcare, improving pain and dysfunction. Patients with chronic pain are a heterogeneous group where outcome of treatment might be influenced by individual resilience and/or vulnerability.
本试点研究旨在描述职业医疗保健中患有慢性工作相关肌肉骨骼疼痛患者的脆弱性和复原力以及可能的亚组。第二个目的是评估以患者为中心的方法。
本研究基于连续的慢性疼痛患者，由同一位医生诊治，且已全时或半时病假三个月或更长时间。他们在三个月的时间段内被纳入研究。在基线和8个月随访时采用患者报告结局测量（PROM）。采用以患者为中心的方法，将患者的整体情况考虑在内。
在基线和随访时均报告存在不安全的拒绝依恋模式占主导以及连贯感（SOC）低于正常水平的情况。患者（n = 38）在多维疼痛量表（MPI）上报告疼痛严重程度（= 0.01）、疼痛干扰（= 0.001）、生活控制（= 0.01）、情感困扰（= 0.02）和功能障碍（= 0.001）有显著改善，且随访时全时病假的患者减少（13例患者对21例）。通过多变量数据分析，MPI的这种变化得到证实，并且还与健康相关生活质量（HRQoL）的显著提高相关。此外，根据依恋模式和MPI亚组确定了随访时有不同结局的亚组。
以患者为中心的方法对于职业医疗保健中的慢性疼痛患者可能有价值，可改善疼痛和功能障碍。慢性疼痛患者是一个异质性群体，治疗结局可能受个体复原力和/或脆弱性的影响。
