From the, Division of Emergency Medicine, Department of Surgery, Duke University, Durham, NC.
the, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
Acad Emerg Med. 2020 Aug;27(8):725-733. doi: 10.1111/acem.13957. Epub 2020 Mar 31.
Low back pain (LBP) is a common reason for patients to present to emergency departments (EDs). Our objective was to describe the associations between depressive symptoms, pain severity, and functional impairment up to 3 months after initial ED presentation for LBP.
We performed a secondary analysis on an observational cohort of adult patients from a high-volume, urban ED. Initial depressive symptoms (Patient Health Questionnaire-9) and disability (Roland Morris Disability Questionnaire) were collected in person at the time of initial ED visit and by telephone at 1-week and 3-month follow-ups. Pain intensity (Numeric Rating Scale) was collected at 1-week and 3-month follow-ups. Our primary goal was to determine the associations between initial depressive symptoms and pain intensity and disability scores at 3 months. We also investigated the associations of initial and 3-month change in depressive symptoms with change in disability score from initial presentation to 3 months and change in pain score from 1 week to 3 months.
Of the 674 patients initially enrolled, 362 patients had complete depressive symptom, pain, and disability data and were included in the final analysis. Those with higher levels of intake depressive symptoms had worse pain intensity (B = 0.14, 95% confidence interval [CI] = 0.08 to 0.21) and disability (0.46, 95% CI = 0.30 to 0.62) severity at 3 months, with less improvement in disability over the 3 months (B = 0.22, 95% CI = 0.05 to 0.40). Furthermore, those with worsening depressive symptoms over the 3-month study period experienced less improvement in pain intensity (B = 0.10, 95% CI = 0.05 to 0.17) and disability (B = 0.84, 95% CI = 0.66 to 1.02) over the same time frame. Except for a slight strengthening of the association between initial depressive symptom severity and 3-month pain score among patients with no prior LBP episodes, history of prior LBP episodes did not moderate these relationships.
Significant positive temporal associations exist between initial severity and 3-month progression of depressive symptoms and 3-month pain intensity and disability outcomes for ED patients with LBP. Future work is needed to investigate whether behavioral interventions initiated from the ED may mitigate the incidence and severity of LBP-related chronic pain and functional impairments.
下腰痛（LBP）是患者到急诊科（ED）就诊的常见原因。我们的目的是描述初始 ED 就诊后 3 个月内抑郁症状、疼痛严重程度和功能障碍之间的关联。
我们对来自大容量城市 ED 的成年患者进行了一项观察性队列的二次分析。初始抑郁症状（患者健康问卷-9）和残疾（Roland Morris 残疾问卷）在 ED 就诊时进行了面对面评估，并在 1 周和 3 个月随访时通过电话进行了评估。疼痛强度（数字评分量表）在 1 周和 3 个月随访时进行了评估。我们的主要目标是确定初始抑郁症状与 3 个月时疼痛强度和残疾评分之间的关联。我们还研究了初始和 3 个月时抑郁症状变化与从初始就诊到 3 个月时残疾评分变化以及从 1 周到 3 个月时疼痛评分变化之间的关联。
在最初纳入的 674 名患者中，有 362 名患者具有完整的抑郁症状、疼痛和残疾数据，并纳入最终分析。那些抑郁症状程度较高的患者在 3 个月时的疼痛强度（B=0.14，95%置信区间 [CI]0.08 至 0.21）和残疾（0.46，95%CI0.30 至 0.62）严重程度更高，且在 3 个月期间残疾改善较少（B=0.22，95%CI0.05 至 0.40）。此外，在 3 个月的研究期间，抑郁症状恶化的患者在疼痛强度（B=0.10，95%CI0.05 至 0.17）和残疾（B=0.84，95%CI0.66 至 1.02）方面的改善也较少。除了先前无 LBP 发作的患者中初始抑郁症状严重程度与 3 个月时疼痛评分之间的关联略有增强外，先前 LBP 发作的病史并未调节这些关系。
对于 ED 就诊的 LBP 患者，初始严重程度与 3 个月时抑郁症状和 3 个月时疼痛强度和残疾结局的进展之间存在显著的正时间关联。需要进一步研究是否可以从 ED 开始实施行为干预来减轻 LBP 相关慢性疼痛和功能障碍的发生率和严重程度。
