慢性难治性肌肉骨骼疼痛综合征多模式住院治疗方案即刻反应的临床预测因素——一项横断面研究

Clinical predictors of immediate response to a multimodal inpatient programme for chronic refractory musculoskeletal pain syndromes-a cross-sectional study.

作者信息

Pretat Tiffany, Hügle Thomas, Mettler Johanna, Suter Marc, Jean-Scherb Sandy, Ming-Azevedo Pedro

机构信息

Department of Rheumatology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.

Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.

出版信息

Rheumatol Adv Pract. 2025 Mar 18;9(2):rkaf024. doi: 10.1093/rap/rkaf024. eCollection 2025.

DOI:10.1093/rap/rkaf024

PMID:40290489

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12033028/

Abstract

OBJECTIVES

Chronic pain (CP) affects approximately 20% of the global population, leading to significant disability and economic burden. Multimodal programmes (MMPs) are the most effective short-term interventions for managing musculoskeletal chronic pain syndromes (MCPS). However, patient characteristics influence treatment response, requiring personalized approaches. This study aims to identify clinical, social and psycho-behavioural predictors of immediate response to a 2-week inpatient MMP for refractory MCPS.

METHODS

A cross-sectional study analysed 207 MCPS patients who completed an MMP at CHUV Lausanne, Switzerland, from March 2018 to November 2022. Validated questionnaires assessed pain severity, impact, kinesiophobia, catastrophizing and other factors before and after the programme. Univariate and multivariate analyses identified predictors of treatment response.

RESULTS

Significant improvements were observed in 9 out of 12 outcomes, including pain severity ( = 0.01), pain impact ( < 0.01), disability ( = 0.14), kinesiophobia (<0.001) and catastrophizing ( < 0.001). Non-specific low-back pain, catastrophizing at entry, biomechanical disorders and psychiatric conditions were identified as key predictors of treatment response, respectively influencing 4, 3, 3 and 2 over 9 outcome measures in multivariable analysis. Non-specific low-back pain was linked to worse outcomes, whereas reductions in catastrophizing correlated with improved pain severity and kinesiophobia. Socioeconomic factors, such as disputes over disability financial aid, also influenced outcomes.

CONCLUSION

This study confirms a modest yet significant immediate benefit of MMP for patients with refractory MCPS and provided a deeper insight into the predictors of treatment outcomes and their influence on various outcome measures. Further longitudinal studies are needed to confirm these findings and explore underlying mechanisms.

摘要

目的

慢性疼痛（CP）影响着全球约20%的人口，导致严重的残疾和经济负担。多模式方案（MMPs）是管理肌肉骨骼慢性疼痛综合征（MCPS）最有效的短期干预措施。然而，患者特征会影响治疗反应，需要个性化方法。本研究旨在确定难治性MCPS患者对为期2周的住院MMP立即反应的临床、社会和心理行为预测因素。

方法

一项横断面研究分析了2018年3月至2022年11月在瑞士洛桑大学中心医院完成MMP的207例MCPS患者。经过验证的问卷在方案前后评估疼痛严重程度、影响、运动恐惧、灾难化思维和其他因素。单因素和多因素分析确定了治疗反应的预测因素。

结果

12项结果中的9项有显著改善，包括疼痛严重程度（P = 0.01）、疼痛影响（P < 0.01）、残疾（P = 0.14）、运动恐惧（P < 0.001）和灾难化思维（P < 0.001）。非特异性下背痛、入院时的灾难化思维、生物力学紊乱和精神疾病被确定为治疗反应的关键预测因素，在多变量分析中分别影响9项结果指标中的4项、3项、3项和2项。非特异性下背痛与较差的结果相关，而灾难化思维的减轻与疼痛严重程度和运动恐惧的改善相关。社会经济因素，如残疾经济援助纠纷，也会影响结果。