School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic.
Clin J Pain. 2021 May 1;37(5):313-320. doi: 10.1097/AJP.0000000000000926.
The term flare is commonly used to describe low back pain (LBP) fluctuations, but individuals with LBP consider that it does not always correspond to increased pain. This case cross-over study aimed to: (1) determine the extent to which days with a flare identified according to a multidimensional definition (self-reported flare, SRF) corresponded to days with greater than average pain (pain-defined flare, PDF) and (2) to investigate whether physical and psychosocial features differ between PDF and SRF.
Individuals with LBP for ≥3 months (N=126) provided data on flares, physical, and psychosocial features daily for 28 days using a smartphone application.
Most days with SRF (68%) did not have greater than average pain (ie, PDF), but most days with greater than average pain (64%) were reported as an SRF. On days with SRF-only all physical and psychosocial features were worse than nonflare days. SRF+PDF had lower sleep quality and higher pain intensity, fatigue, disability, pain catastrophizing, and fear avoidance than SRF-only. SRF+PDF had higher pain in the afternoon and evening, disability and pain catastrophizing than PDF-only. Self-efficacy at work and during leisure activities was worse on SRF+PDF days than SRF-only and PDF-only days.
These findings highlight that when individuals with LBP consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features. This emphasizes that flare has broader dimensions than pain alone. Consideration of flare according to broad dimensions is important when investigating symptom fluctuations across different LBP trajectories.
“ flare ”一词通常用于描述下背痛（LBP）波动，但患有 LBP 的个体认为它并不总是对应于疼痛增加。本病例交叉研究旨在：（1）确定根据多维定义（自我报告 flare ，SRF ）确定的 flare 天数与疼痛高于平均水平的天数（疼痛定义 flare ，PDF ）之间的对应程度；（2）调查 PDF 和 SRF 之间的物理和心理社会特征是否存在差异。
患有 LBP 超过 3 个月的个体（N=126）使用智能手机应用程序在 28 天内每天提供关于 flare 、身体和心理社会特征的数据。
大多数具有 SRF 的天数（68%）没有高于平均水平的疼痛（即 PDF ），但大多数高于平均水平的疼痛天数（64%）被报告为 SRF 。在仅具有 SRF 的日子里，所有的身体和心理社会特征都比非 flare 日子更差。SRF+PDF 的睡眠质量较低，疼痛强度、疲劳、残疾、疼痛灾难化和恐惧回避均高于 SRF 仅。SRF+PDF 在下午和晚上的疼痛、残疾和疼痛灾难化均高于 PDF 仅。在 SRF+PDF 日，工作和休闲活动时的自我效能感比 SRF 仅和 PDF 仅差。
这些发现强调，当患有 LBP 的个体认为他们有 flare 时，他们并不总是有高于平均水平的疼痛，但有更差的心理社会特征。这强调 flare 比疼痛本身具有更广泛的维度。在研究不同 LBP 轨迹的症状波动时，考虑 flare 根据广泛的维度很重要。
