共病失眠和精神困扰在腰椎间盘退变与腰痛相关残疾之间的关联中的作用。
The role of co-occurring insomnia and mental distress in the association between lumbar disc degeneration and low back pain related disability.
机构信息
Faculty of Medicine and Health Technology, Tampere University Hospital and University of Tampere, P.O. Box 607, Tampere, FI-33014, Finland.
Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O. Box 5000, Oulu, FI- 90014, Finland.
出版信息
BMC Musculoskelet Disord. 2023 Apr 14;24(1):293. doi: 10.1186/s12891-023-06365-2.
BACKGROUND
Lumbar disc degeneration (LDD) is associated with low back pain (LBP). Although both insomnia and mental distress appear to influence the pain experience, their role in the association between LDD and LBP is uncertain. Our objective was to investigate the role of co-occurring insomnia and mental distress in the association between LDD and LBP-related disability.
METHODS
A total of 1080 individuals who had experienced LBP during the previous year underwent 1.5-T lumbar magnetic resonance imaging, responded to questionnaires, and participated in a clinical examination at the age of 47. Full data was available for 843 individuals. The presence of LBP and LBP-related disability (numerical rating scale, range 0-10) were assessed using a questionnaire. LDD was assessed by a Pfirrmann-based sum score (range 0-15, higher values indicating higher LDD). The role of insomnia (according to the five-item Athens Insomnia Scale) and mental distress (according to the Hopkins Symptom Check List-25) in the association between the LDD sum score and LBP-related disability was analyzed using linear regression with adjustments for sex, smoking, body mass index, education, leisure-time physical activity, occupational physical exposure, Modic changes, and disc herniations.
RESULTS
A positive association between LDD and LBP-related disability was observed among those with absence of both mental distress and insomnia (adjusted B = 0.132, 95% CI = 0.028-0.236, p = 0.013), and among those with either isolated mental distress (B = 0.345 CI = 0.039-0.650, p = 0.028) or isolated insomnia (B = 0.207, CI = 0.040-0.373, p = 0.015). However, among individuals with co-occurring insomnia and mental distress, the association was not significant (B = -0.093, CI = -0.346-0.161, p = 0.470).
CONCLUSIONS
LDD does not associate with LBP-related disability when insomnia and mental distress co-occur. This finding may be useful when planning treatment and rehabilitation that aim to reduce disability among individuals with LDD and LBP. Future prospective research is warranted.
背景
腰椎间盘退变（LDD）与下腰痛（LBP）有关。尽管失眠和精神困扰似乎都影响疼痛体验，但它们在 LDD 与 LBP 相关性方面的作用尚不确定。我们的目的是研究同时存在的失眠和精神困扰在 LDD 与 LBP 相关残疾之间的关联中的作用。
方法
共有 1080 名在过去一年中经历过 LBP 的个体接受了 1.5-T 腰椎磁共振成像，回答了问卷，并在 47 岁时参加了临床检查。843 名个体提供了完整的数据。使用问卷评估 LBP 和 LBP 相关残疾（数字评分量表，范围 0-10）。通过基于 Pfirrmann 的总分（范围 0-15，分数越高表示 LDD 越高）评估 LDD。使用线性回归分析，根据 Athens 失眠量表（五分量表）评估失眠的作用，根据 Hopkins 症状检查清单-25 评估精神困扰的作用，调整性别、吸烟、体重指数、教育、休闲时间体育活动、职业物理暴露、Modic 改变和椎间盘突出症后，分析 LDD 总分与 LBP 相关残疾之间的关系。
结果
在既没有精神困扰也没有失眠的个体中，观察到 LDD 与 LBP 相关残疾之间存在正相关（调整后 B=0.132，95%CI=0.028-0.236，p=0.013），在仅存在孤立性精神困扰的个体中（B=0.345，CI=0.039-0.650，p=0.028）或孤立性失眠的个体中（B=0.207，CI=0.040-0.373，p=0.015）也是如此。然而，在同时存在失眠和精神困扰的个体中，这种关联并不显著（B=-0.093，CI=-0.346-0.161，p=0.470）。
结论
当失眠和精神困扰同时存在时，LDD 与 LBP 相关残疾无关。这一发现可能有助于规划旨在减轻 LDD 和 LBP 患者残疾的治疗和康复计划。需要进一步的前瞻性研究。
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