Shigetoh Hayato, Koga Masayuki, Tanaka Yoichi, Morioka Shu
Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan.
Miura Internal Medicine Michiko Pediatrics Clinic, Kagawa, Japan.
Pain Res Manag. 2020 Oct 30;2020:8844219. doi: 10.1155/2020/8844219. eCollection 2020.
The process of pain recovery varies and can include the recovery, maintenance, or worsening of symptoms. Many cases of patients with pain show a tendency of recovering as predicted; however, some do not. The characteristics of cases that do not fit the prediction of pain recovery remain unclear. We performed cluster and decision tree analyses to reveal the characteristics in cases that do not fit the prediction of pain recovery. A total of 43 patients with musculoskeletal pain (nonoperative: 22 patients, operative: 13 patients) and central pain (brain disease: 5 patients, spinal cord disease: 3 patients) were included in this longitudinal study. Central sensitivity syndrome (CSS) outcome measures (Central Sensitisation Inventory), pain intensity-related outcome measures (Short-Form McGill Pain Questionnaire-2 (SFMPQ-2)), and cognitive-emotional outcome measures (Hospital Anxiety and Depression Scale and Pain Catastrophising Scale-4) of all patients were assessed at baseline and after 1-2 months. Regression analysis was used to calculate pain recovery prediction values. A hierarchical cluster analysis based on the predicted change of SFMPQ-2 and the observed change of SFMPQ-2 was used to extract subgroups that fit and those that do not fit pain recovery prediction. To extract the characteristics of subgroups that do not fit the prediction of pain recovery, a decision tree analysis was performed. The level of significance was set at 5%. In the results of cluster analysis, patients were classified into three subgroups. Cluster 1 was characterised by worse pain intensity from baseline, cluster 2 by pain, having recovered less and mildly than the predicted value, and Cluster 3 by a marked recovery of pain. In the results of the decision tree analysis, the CSI change was extracted as an indicator related to the classification of all clusters. Our findings suggest that the poor improvement of CSS is characteristic in cases that do not fit the prediction of pain recovery.
疼痛恢复的过程各不相同，可能包括症状的恢复、维持或恶化。许多疼痛患者的情况显示出如预期般恢复的趋势；然而，有些患者并非如此。不符合疼痛恢复预测的病例特征仍不清楚。我们进行了聚类和决策树分析，以揭示不符合疼痛恢复预测的病例特征。本纵向研究共纳入了43例肌肉骨骼疼痛患者（非手术患者：22例，手术患者：13例）以及中枢性疼痛患者（脑部疾病患者：5例，脊髓疾病患者：3例）。在基线以及1 - 2个月后，对所有患者的中枢敏化综合征（CSS）结局指标（中枢敏化量表）、疼痛强度相关结局指标（简化麦吉尔疼痛问卷-2（SFMPQ-2））以及认知-情绪结局指标（医院焦虑抑郁量表和疼痛灾难化量表-4）进行了评估。采用回归分析计算疼痛恢复预测值。基于SFMPQ-2的预测变化和观察到的SFMPQ-2变化进行层次聚类分析，以提取符合和不符合疼痛恢复预测的亚组。为了提取不符合疼痛恢复预测的亚组特征，进行了决策树分析。显著性水平设定为5%。在聚类分析结果中，患者被分为三个亚组。第1组的特征是与基线相比疼痛强度更差，第2组的特征是疼痛恢复程度低于预测值且恢复程度较轻，第3组的特征是疼痛明显恢复。在决策树分析结果中，CSI变化被提取为与所有聚类分类相关的指标。我们的研究结果表明，CSS改善不佳是不符合疼痛恢复预测的病例的特征。
