Carlesso Lisa C, Tousignant-Laflamme Yannick, Shaw William, Larivière Christian, Choinière Manon
School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.
School of Rehabilitation, Université de Montréal, Montréal, Quebec, Canada.
Can J Pain. 2021 Mar 3;5(1):43-55. doi: 10.1080/24740527.2020.1870103.
: Chronic low back pain (CLBP) is a major cause of disability globally. Stratified care has been proposed as a means to improve prognosis and treatment but is generally based on limited aspects of pain, including biopsychosocial drivers. : Following Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations, the present study explored pain phenotypes with a sample of workers with CLBP, a population for which no pain phenotypes have been derived to date. : A cross-sectional design was used with a sample of 154 workers with CLBP attending a rehabilitation clinic, recruited in person and from social media. Latent class analysis was used to identify subgroups of patients with different pain profiles based on ten pain indicators (pain variability, pain intensity, pain quality, somatization, sleep quality, depression, fatigue, pain catastrophizing, neuropathic pain, and central sensitization). : The majority of the sample (85%) were recruited through social media. Both the two-class and three-class solutions were found to be satisfactory in distinguishing phenotypes of workers with CLBP. Three variables proved particularly important in distinguishing between the pain phenotypes-pain quality, fatigue, and central sensitization-with higher scores on these indicators associated with pain phenotypes with higher pain burden. Increased chronic pain self-efficacy, work-related support, and perceived work abilities were protective risk factors for being in a higher pain burden class. : The present study is the first to explore IMMPACT recommendations for pain phenotyping with workers with CLBP. Future prospective research will be needed to validate the proposed pain phenotypes.
慢性下腰痛（CLBP）是全球致残的主要原因。分层护理已被提议作为改善预后和治疗的一种手段，但通常基于疼痛的有限方面，包括生物心理社会驱动因素。
遵循临床试验中的方法、测量和疼痛评估倡议（IMMPACT）的建议，本研究以患有CLBP的工人样本为对象，探索疼痛表型，迄今为止尚未从该人群中得出疼痛表型。
采用横断面设计，对154名在康复诊所就诊的患有CLBP的工人样本进行研究，这些样本通过个人招募和社交媒体招募。基于十个疼痛指标（疼痛变异性、疼痛强度、疼痛性质、躯体化、睡眠质量、抑郁、疲劳、疼痛灾难化、神经性疼痛和中枢敏化），使用潜在类别分析来识别具有不同疼痛特征的患者亚组。
大部分样本（85%）是通过社交媒体招募的。发现两类和三类解决方案在区分患有CLBP的工人的表型方面都令人满意。三个变量在区分疼痛表型方面被证明特别重要——疼痛性质、疲劳和中枢敏化——这些指标得分越高，与疼痛负担越高的疼痛表型相关。慢性疼痛自我效能感、工作相关支持和感知工作能力的提高是处于较高疼痛负担类别的保护性风险因素。
本研究是首次探索IMMPACT对患有CLBP的工人进行疼痛表型分析的建议。未来需要进行前瞻性研究来验证所提出的疼痛表型。
