University of Trieste.
Gastroenterology, Digestive Endoscopy and Clinical Nutrition Unit, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste.
J Pediatr Gastroenterol Nutr. 2019 Oct;69(4):e99-e104. doi: 10.1097/MPG.0000000000002447.
Inflammatory bowel disease (IBD) can be particularly challenging during the pediatric age with a relevant impact on patient's health-related quality of life (HRQoL). Disease activity accounts for only a small part of the variability in HRQoL, and psychological factors can play a significant role. We aimed to evaluate the impact of patient's distress and pain catastrophizing on children and adolescents with IBD.
We prospectively recruited children aged 8 to 18 with IBD and recorded demographic and disease characteristics. Patients answered questionnaires on HRQoL (IMPACT III), distress (distress thermometer [DT]), and pain catastrophizing (Pain Catastrophizing Scale-Children [PCS-C]). Univariate and multivariate regression models analysis were used to evaluate correlations between patients' characteristics, disease activity, distress, pain catastrophizing, and HRQoL.
Seventy-one patients were enrolled (median age 13.6, 49.3% Crohn disease, 50.7% ulcerative colitis). Median HRQoL, DT, and PCS-C scores were 78.6 (interquartile range 68.0-87.1), 3.0 (1.0-5.0), and 12.0 (4.0-23.0), respectively. Patient's distress and pain catastrophizing levels significantly correlated with HRQoL. Pain catastrophizing had the strongest impact on HRQoL (Spearman correlation coefficient, ρ = 0.73), followed by distress (ρ = 0.67), and ulcerative colitis severity (ρ = 0.67). The DT and the PCS-C scores were significantly associated (ρ = 0.46).
Distress and pain catastrophizing have a significative impact on HRQoL in young patients with IBD. Physicians should recognize the role of these psychological factors and consider cognitive-behavioral therapy to optimize the patient's health.
炎症性肠病（IBD）在儿科时期可能特别具有挑战性，对患者的健康相关生活质量（HRQoL）有重大影响。疾病活动度仅占 HRQoL 可变性的一小部分，而心理因素可能起重要作用。我们旨在评估患者的痛苦和疼痛灾难化对 IBD 患儿和青少年的影响。
我们前瞻性招募了 8 至 18 岁患有 IBD 的儿童，并记录了人口统计学和疾病特征。患者回答了 HRQoL（IMPACT III）、痛苦（痛苦温度计[DT]）和疼痛灾难化（儿童疼痛灾难化量表[PCS-C]）问卷。使用单变量和多变量回归模型分析来评估患者特征、疾病活动度、痛苦、疼痛灾难化和 HRQoL 之间的相关性。
共纳入 71 例患者（中位年龄 13.6 岁，49.3%克罗恩病，50.7%溃疡性结肠炎）。中位 HRQoL、DT 和 PCS-C 评分分别为 78.6（四分位距 68.0-87.1）、3.0（1.0-5.0）和 12.0（4.0-23.0）。患者的痛苦和疼痛灾难化水平与 HRQoL 显著相关。疼痛灾难化对 HRQoL 的影响最大（Spearman 相关系数，ρ=0.73），其次是痛苦（ρ=0.67）和溃疡性结肠炎严重程度（ρ=0.67）。DT 和 PCS-C 评分之间存在显著相关性（ρ=0.46）。
痛苦和疼痛灾难化对年轻 IBD 患者的 HRQoL 有显著影响。医生应认识到这些心理因素的作用，并考虑认知行为疗法来优化患者的健康。
