Sipilä Reetta, Kemp Harriet, Harno Hanna, Rice Andrew S C, Kalso Eija
Department of Anesthesiology, Intensive Care and Pain Medicine, Division of Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
SleepWell Research Programme, University of Helsinki, Helsinki, Finland.
Scand J Pain. 2021 Mar 17;21(3):512-521. doi: 10.1515/sjpain-2020-0177. Print 2021 Jul 27.
Persistent pain is common in HIV patients and breast cancer (BC) survivors. The aim of this study was to compare two patient groups with neuropathic pain (NP) regarding several psychological variables and Health-related Quality of Life. Although, treatment of pain is always planned individually, the knowledge of the differences and similarities between the patient groups may help us to understand more precisely the targets of the interventions for pain.
Eighty nine BC and 73 HIV patients with symptoms of neuropathic pain (patients with ≥3/7 in the Douleur Neuropathique four interview part (DN4i)) participated in a cross-sectional study. Patients completed questionnaires about mood (HADS), symptoms of insomnia (ISI), pain catastrophizing (PCS), personality (TIPI), Mental and Physical Health-related Quality of Life (M/PHrQoL, RAND/SF-36), and pain intensity and interference (BPI). Analyses were applied by using t-tests and linear regression to assess associations between the studied factors.
HIV patients reported higher anxiety (p<0.001), depressive symptoms (p<0.001), pain catastrophizing (p<0.001) and pain interference (p<0.001), poorer sleep (p<0.001), and lower HrQoL in all dimensions compared with BC survivors. There were significant differences in personality traits extraversion, emotional stability, and agreeableness between the two patient groups. In HIV patients, pain interference (=-0.344, p<0.001) and mood (=-0.580, p<0.001) and in the BC group, mood (=-0.591, p<0.001), extraversion (=0.229, p=0.005) and sleep (=-0.154, p=0.042) associated with MHrQoL. Pain interference (HIV =-0.645, p<0.001, BC =-0.491, p<0.001) and age (HIV =-0.016, p=0.042 and BC =-0.018, p=0.019) associated with PHrQoL in both groups, and catastrophizing in the BC group (=-0.303, p<0.001).
HIV patients and BC survivors with neuropathic pain, measured with DN4i, have significant differences in various health-related variables and Health-related Quality of Life with both patient groups reporting low HrQoL. The differences in low HrQoL may reflect the fundamental differences between these diseases, BC survivors in remission and HIV patients living with a chronic disease that is under control. This study brings information about the diversity of different patient populations with symptoms of neuropathic pain, and how neuropathic pain associates with wide range of health-related factors. Interventions to support better coping with the symptoms of neuropathic pain could be tailored more individually if the background disease is taken into account.
持续性疼痛在艾滋病患者和乳腺癌（BC）幸存者中很常见。本研究的目的是比较两组患有神经性疼痛（NP）的患者在几个心理变量和健康相关生活质量方面的情况。尽管疼痛治疗总是根据个体情况进行规划，但了解患者群体之间的异同可能有助于我们更准确地理解疼痛干预的目标。
89名患有神经性疼痛症状的乳腺癌患者和73名艾滋病患者（在神经病理性疼痛四部分访谈（DN4i）中得分≥3/7的患者）参与了一项横断面研究。患者完成了关于情绪（医院焦虑抑郁量表（HADS））、失眠症状（失眠严重程度指数（ISI））、疼痛灾难化（疼痛灾难化量表（PCS））、人格（大五人格简式量表（TIPI））、心理和身体健康相关生活质量（M/PHrQoL，兰德36项健康调查简表（RAND/SF - 36））以及疼痛强度和干扰（简明疼痛问卷（BPI））的问卷调查。采用t检验和线性回归进行分析，以评估研究因素之间的关联。
与乳腺癌幸存者相比，艾滋病患者报告有更高的焦虑（p<0.001）、抑郁症状（p<0.001）、疼痛灾难化（p<0.001）和疼痛干扰（p<0.001），睡眠质量更差（p<0.001），并且在所有维度上的健康相关生活质量更低。两组患者在外向性、情绪稳定性和宜人性等人格特质方面存在显著差异。在艾滋病患者中，疼痛干扰（=-0.344，p<0.001）和情绪（=-0.580，p<0.001），在乳腺癌组中，情绪（=-0.591，p<0.001）、外向性（=0.229，p = 0.005）和睡眠（=-0.154，p = 0.042）与心理健康相关生活质量相关。疼痛干扰（艾滋病组=-0.645，p<0.001，乳腺癌组=-0.491，p<0.001）和年龄（艾滋病组=-0.016，p = 0.042，乳腺癌组=-0.018，p = 0.019）与两组的身体健康相关生活质量相关，并且乳腺癌组的灾难化（=-0.303，p<0.001）也与之相关。
用DN4i测量的患有神经性疼痛的艾滋病患者和乳腺癌幸存者在各种健康相关变量和健康相关生活质量方面存在显著差异，两组患者的健康相关生活质量均较低。健康相关生活质量低的差异可能反映了这些疾病之间的根本差异，即处于缓解期的乳腺癌幸存者和病情得到控制的慢性病艾滋病患者之间的差异。本研究提供了有关不同患有神经性疼痛症状患者群体的多样性信息，以及神经性疼痛如何与广泛的健康相关因素相关联的信息。如果考虑到基础疾病，支持更好地应对神经性疼痛症状的干预措施可以更个性化地制定。
