慢性偏头痛患者慢性重叠性疼痛状况的特征：CHOIR 研究。
Characterization of chronic overlapping pain conditions in patients with chronic migraine: A CHOIR study.
机构信息
Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA.
出版信息
Headache. 2021 Jun;61(6):872-881. doi: 10.1111/head.14129. Epub 2021 Jun 29.
OBJECTIVE
Chronic overlapping pain conditions (COPCs) represent a co-aggregation of widespread pain disorders. We characterized differences in physical and psychosocial functioning in patients with chronic migraine (CM) and those with CM and COPCs.
BACKGROUND
Patients with CM and COPCs have been identified as a distinct subgroup of patients with CM, and these patients may be vulnerable to greater symptom severity and burden.
METHODS
Data were extracted from Collaborative Health Outcomes Information Registry (an open-source learning health-care system), completed at the patients' first visit at a large tertiary care pain management center and electronic medical records. In 1601 patients with CM, the number of non-cephalic areas of pain endorsed on a body map was used to examine the differences in pain, physical and psychosocial function, adverse life experience, and health-care utilization.
RESULTS
Patients endorsing more body map regions reported significantly worse symptoms and function across all domains. Scored on a t-score metric (mean = 50, SD = 10), endorsement of one additional body map region corresponded with a 0.69-point increase in pain interference (95% CI = 0.55, 0.82; p < 0.001; Cohen's f = 0.328), 1.15-point increase in fatigue (95% CI = 0.97, 1.32; p < 0.001; Cohen's f = 0.432), and 1.21-point decrease in physical function (95% CI = -1.39, -1.03; p < 0.001; Cohen's f = 0.560). Patients with more widespread pain reported approximately 5% more physician visits (95% CI = 0.03, 0.07; p < 0.001), and patients reporting adverse life events prior to age 17 endorsed 22% more body map regions (95% CI = 0.11, 0.32; p < 0.001).
CONCLUSIONS
Patients with CM and other overlapping pain conditions as noted on the body map report significantly worse pain-related physical function, psychosocial functioning, increased health-care utilization, and greater association with adverse life experiences, compared with those with localized CM. This study provides further evidence that patients with CM and co-occurring pain conditions are a distinct subgroup of CM and can be easily identified through patient-reported outcome measures.
目的
慢性重叠性疼痛病症（COPCs）代表了广泛疼痛障碍的共同聚集。我们对慢性偏头痛（CM）患者和同时患有 CM 和 COPCs 的患者的身体和心理社会功能差异进行了描述。
背景
患有 CM 和 COPCs 的患者已被确定为 CM 患者的一个特定亚组，这些患者可能更容易出现更严重的症状和负担。
方法
数据取自合作健康结果信息注册处（一个开源学习型医疗保健系统），在大型三级护理疼痛管理中心和电子病历中，从患者首次就诊时提取。在 1601 名 CM 患者中，使用身体图上认可的非头部区域疼痛的数量来检查疼痛、身体和心理社会功能、不良生活经历和医疗保健利用方面的差异。
结果
认可更多身体图区域的患者在所有领域的症状和功能都显著恶化。在 t 分数量表上评分（平均值=50，标准差=10），认可一个额外的身体图区域对应于疼痛干扰增加 0.69 分（95%置信区间=0.55，0.82；p<0.001；Cohen's f=0.328），疲劳增加 1.15 分（95%置信区间=0.97，1.32；p<0.001；Cohen's f=0.432），身体功能下降 1.21 分（95%置信区间=-1.39，-1.03；p<0.001；Cohen's f=0.560）。疼痛更广泛的患者报告的医生就诊次数约增加 5%（95%置信区间=0.03，0.07；p<0.001），报告 17 岁前发生不良生活事件的患者认可的身体图区域增加 22%（95%置信区间=0.11，0.32；p<0.001）。
结论
与局灶性 CM 患者相比，在身体图上记录有 CM 和其他重叠性疼痛病症的患者报告的疼痛相关身体功能、心理社会功能更差，医疗保健利用率更高，与不良生活经历的关联更大。这项研究进一步证明，患有 CM 和同时存在的疼痛病症的患者是 CM 的一个特定亚组，可以通过患者报告的结果测量轻松识别。
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