Rometsch Caroline, Ott Stephan, Festl-Wietek Teresa, Jurjut Anna-Maria, Schlisio Barbara, Zipfel Stephan, Stengel Andreas, Herrmann-Werner Anne
University Hospital and Faculty of Medicine, University of Tübingen, Tübingen, Germany.
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Front Psychiatry. 2023 Jan 6;13:1033020. doi: 10.3389/fpsyt.2022.1033020. eCollection 2022.
BACKGROUND: Chronic pain (CP), a complex biopsychosocial disorder with a global prevalence of up to 33%, can be treated by following multidisciplinary approaches that may include cannabis-based medicine (CBM). However, because CBM continues to be a new treatment, questions remain regarding the ideal duration for CBM and its psychosocial determinants, including mental comorbidities. METHODS: In a retrospective cross-sectional study involving 46 patients with CP (ICD-10 code F45.4-), three validated instruments-the German Pain Questionnaire, the Depression Anxiety Stress Scale (DASS), and the Marburg Questionnaire of Habitual WellBeing-were used to identify pain-specific psychosocial determinants and mental disorders. Descriptive analyses, a group differences analysis, and a logistic regression analysis were performed using SPSS. RESULTS: The patients most frequently reported low back pain as the primary location of their CP, and in attributing the condition to tissue damage, most had largely adopted a somatic orientation in conceptualizing their illness. Most had experienced CP for more than 5 years ( = 5.13 years, SD = 1.41) and, as a consequence, faced significant restrictions in their everyday life and exhibited low subjective wellbeing (MFHW median = 4.00, = 43, Q1: 2.00, Q3: 9.00, range: 0-20). Comorbidities among the patients included depression, (DASS-Depression, median: 11.50, Q1: 7.00, Q3: 16.25), anxiety (DASS-Anxiety, median: 4.50, Q1: 2.75, Q3: 8.00), and stress (DASS-Stress, median: 11.00, Q1: 7.00, Q3: 15.00). Between the two cannabis-based treatments with a course lasting either less or more than a year, the duration of treatment showed no between-group differences in terms of sociodemographic factors, pain-specific factors, conceptualizations of the illness, or mental disorders. Psychosocial determinants such as subjective wellbeing and mental comorbidities were not significant predictors of the duration of cannabis-based treatment. CONCLUSION: We found no evidence indicating that the benefits of short-term vs. long-term cannabis-based treatment can be predicted by mental comorbidities or psychosocial factors. However, because CBM may be included in approaches to treat CP, questions about the ideal duration of such treatment remain to be answered.
背景：慢性疼痛（CP）是一种复杂的生物心理社会障碍，全球患病率高达33%，可通过多学科方法进行治疗，其中可能包括基于大麻的药物（CBM）。然而，由于CBM仍是一种新的治疗方法，关于CBM的理想疗程及其心理社会决定因素（包括精神共病）仍存在疑问。 方法：在一项涉及46例CP患者（国际疾病分类第十版代码F45.4-）的回顾性横断面研究中，使用了三种经过验证的工具——德国疼痛问卷、抑郁焦虑压力量表（DASS）和马尔堡习惯性幸福感问卷——来确定疼痛特异性心理社会决定因素和精神障碍。使用SPSS进行描述性分析、组间差异分析和逻辑回归分析。 结果：患者最常报告下背部疼痛是其CP的主要部位，在将病情归因于组织损伤时，大多数人在对疾病的概念化上很大程度上采用了躯体取向。大多数人经历CP超过5年（平均 = 5.13年，标准差 = 1.41），因此，他们在日常生活中面临重大限制，主观幸福感较低（马尔堡习惯性幸福感问卷中位数 = 4.00，范围 = 43，第一四分位数：2.00，第三四分位数：9.00，范围：0 - 20）。患者的共病包括抑郁症（DASS - 抑郁，中位数：11.50，第一四分位数：7.00，第三四分位数：16.25）、焦虑症（DASS - 焦虑，中位数：4.50，第一四分位数：2.75，第三四分位数：8.00）和压力（DASS - 压力，中位数：11.00，第一四分位数：7.00，第三四分位数：15.00）。在疗程持续时间少于或多于一年的两种基于大麻的治疗之间，治疗持续时间在社会人口学因素、疼痛特异性因素、疾病概念化或精神障碍方面没有组间差异。主观幸福感和精神共病等心理社会决定因素不是基于大麻治疗持续时间的显著预测因素。 结论：我们没有发现证据表明精神共病或心理社会因素可以预测短期与长期基于大麻治疗的益处。然而，由于CBM可能被纳入CP的治疗方法中，关于这种治疗的理想疗程的问题仍有待回答。
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