Versus Arthritis Centre for Epidemiology and the NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust; The University of Manchester, Manchester, United Kingdom.
Academic Unit of Palliative Care, Leeds Institute of Health Research, University of Leeds, Leeds, United Kingdom.
Pain. 2019 Aug;160(8):1817-1823. doi: 10.1097/j.pain.0000000000001568.
This study was performed to test whether the risk of developing chronic widespread pain (CWP) in those with regional pain was augmented in those with symptoms of neuropathic pain (NP). Persons free of CWP completed the Douleur Neuropathique 4 (scores ≥3 indicating NP); demographics; Hospital Anxiety and Depression scale; Pittsburgh Sleep Quality Index; and pain medications. Participants were classified as having no pain, regional pain with no symptoms of NP ((Equation is included in full-text article.)), or regional pain with symptoms of NP (NP). At the 12-month follow-up, participants with CWP were identified. Logistic regression estimated the odds ratio, with 95% confidence intervals, of CWP in the (Equation is included in full-text article.)and NP groups compared with no pain, and NP compared with (Equation is included in full-text article.). Partial population attributable risks estimated the proportion of CWP attributable to baseline (Equation is included in full-text article.)or NP exposure. One thousand one hundred sixty-two participants completed the baseline DN4 and provided pain data at follow-up: 523 (45.0%) had no baseline pain, 562 (48.4%) (Equation is included in full-text article.), and 77 (6.6%) NP. One hundred fifty-three (13.2%) had CWP at 12 months: 19 (3.6%) no pain, 108 (19.2%) (Equation is included in full-text article.), and 26 (33.8%) NP. (Equation is included in full-text article.)(2.9 [1.9-4.3]) and NP (2.1 [1.1-4.0]) predicted CWP after adjusting for demographics, Hospital Anxiety and Depression scale, Pittsburgh Sleep Quality Index, and medications. The partial population attributable risk was 41.3% (25.2-54.0) for (Equation is included in full-text article.)and 6.0% (0.1-11.6) for NP. The NP group were not more likely to develop CWP when compared directly with (Equation is included in full-text article.)(1.5 [0.8-2.8]). Neuropathic pain was relatively rare and predicted a small number of new-onset CWP cases. Using these estimates, treatments targeting NP would at best prevent 6% of CWP cases.
本研究旨在测试区域疼痛患者中是否存在神经病理性疼痛（NP）症状会增加其发展为慢性广泛性疼痛（CWP）的风险。无 CWP 的患者完成了 Douleur Neuropathique 4（评分≥3 表示存在 NP）；人口统计学；医院焦虑和抑郁量表；匹兹堡睡眠质量指数；以及止痛药物。参与者被分为无疼痛、有区域疼痛但无 NP 症状（(Equation is included in full-text article.)）、或有区域疼痛和 NP 症状（NP）。在 12 个月的随访中，确定了 CWP 患者。逻辑回归估计了 CWP 在（Equation is included in full-text article.）和 NP 组中的优势比，置信区间为 95%，与无疼痛组进行比较，以及 NP 与（Equation is included in full-text article.）相比。部分人群归因风险估计了基线（Equation is included in full-text article.）或 NP 暴露导致的 CWP 比例。1162 名参与者完成了基线 DN4 并在随访时提供了疼痛数据：523 名（45.0%）基线时无疼痛，562 名（48.4%）（Equation is included in full-text article.），77 名（6.6%）NP。153 名（13.2%）在 12 个月时患有 CWP：19 名（3.6%）无疼痛，108 名（19.2%）（Equation is included in full-text article.），26 名（33.8%）NP。（Equation is included in full-text article.）（2.9[1.9-4.3]）和 NP（2.1[1.1-4.0]）在调整人口统计学、医院焦虑和抑郁量表、匹兹堡睡眠质量指数和药物后预测了 CWP。部分人群归因风险为 41.3%（25.2-54.0），用于（Equation is included in full-text article.），6.0%（0.1-11.6）用于 NP。与（Equation is included in full-text article.）相比，NP 组发展为 CWP 的可能性并没有更高（1.5[0.8-2.8]）。NP 较为少见，预测了少数新出现的 CWP 病例。使用这些估计值，针对 NP 的治疗方法最多只能预防 6%的 CWP 病例。
