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慢性下腰痛患者观察队列中的患者报告结局

Patient-Reported Outcomes Among an Observational Cohort of Individuals With Chronic Low Back Pain.

作者信息

Greco Carol M, Dodds Nathan E, Acevedo Amanda M, Anderst William, Bell Kevin M, Darwin Jessa, Delitto Anthony, Jakicic John M, McKernan Gina P, Patterson Charity G, Pilkonis Paul A, Piva Sara R, Schneider Michael J, Vo Nam V, Wasan Ajay D, Yu Lan, Sowa Gwendolyn A

机构信息

Department of Psychiatry University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA.

Department of Physical Therapy University of Pittsburgh School of Health and Rehabilitation Sciences Pittsburgh Pennsylvania USA.

出版信息

JOR Spine. 2025 Aug 13;8(3):e70097. doi: 10.1002/jsp2.70097. eCollection 2025 Sep.


DOI:10.1002/jsp2.70097
PMID:40809737
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12345597/
Abstract

BACKGROUND: Chronic low back pain (cLBP) is complex, disabling, and costly to patients and to society. Patients' social circumstances, beliefs, and behaviors interact in a dynamic way with biomedical factors and have the potential to amplify or reduce suffering. It is important to assess the experience of pain via patient-reported outcomes (PROs). The University of Pittsburgh Mechanistic Research Center, entitled, " is part of the National Institutes of Health's Helping to End Addiction Long-term Initiative. LBP conducted a prospective, observational cohort study to identify phenotypes of over 1000 participants with cLBP. This article reports key information from the PROs and selected demographic variables obtained at the in-person LBP study enrollment visit. METHODS: The LBP study participants completed numerous PROs, including the minimum data set assessments of the NIH Research Task Force on back pain and the NIH HEAL Initiative's Common Data Elements. PROs were organized into five conceptual domains: (1) Pain Characteristics and Qualities, (2) Pain-related Psychosocial Factors, (3) General Psychosocial Factors, (4) General Health and Lifestyle Factors, and (5) Social Determinants of Health (SDoH). Patient Acceptance of Symptom Status, which consists of yes/no responses to 10 questions about whether the level of each of the 10 symptoms is satisfactory, was also assessed. RESULTS: PRO measures were collected from 1007 LBP participants with cLBP. The means and standard deviations, or medians and interquartile ranges, and percentages for the PRO variables collected at the in-person enrollment visit are presented for the overall group and stratified by sex at birth (females and males) and by age (< 60 years old and ≥ 60 years old). For the participants overall, and across sex and age groups, pain intensity and interference were moderate on average. Neuropathic pain, assessed via PainDETECT, was present in 18% of the overall sample, and in 22.5% of those younger than 60. On average, fatigue, depressive and anxiety symptoms, memory and concentration, self-efficacy, and positive outlook were within normal limits, as indicated by PROMIS T-scores. However, PROMIS Physical function was below normal, with T-scores in the mild to moderate range of impairment. When participants were asked to rate the acceptability of their symptom status in 10 areas of function, the most frequently reported areas of dissatisfaction were: pain intensity and interference, physical function, sleep, and fatigue. In the area of SDoH, nearly half (44%) of participants reported having been exposed to traumatic experiences. In the overall group, 36% reported difficulty paying for basic needs such as food, medical care, and heating, while 51% of those in the < 60 group reported this level of financial strain. CONCLUSIONS: The LBP cLBP observational cohort exhibited moderate levels of pain intensity, pain interference with life activities, and pain-related disability. Participants reported mild to moderate levels of pain-related psychosocial factors, and general mental health challenges such as depression and anxiety were relatively rare. Many participants reported a history of exposure to traumatic experiences and having current financial challenges. The LBP PRO results provide reference values for a community sample of persons with cLBP.

摘要

背景:慢性下腰痛(cLBP)情况复杂,会导致患者残疾,给患者和社会带来高昂代价。患者的社会环境、信念和行为与生物医学因素以动态方式相互作用,有可能加剧或减轻痛苦。通过患者报告结局(PROs)评估疼痛体验很重要。匹兹堡大学机制研究中心是美国国立卫生研究院“帮助终结长期成瘾倡议”的一部分。下腰痛研究开展了一项前瞻性观察队列研究,以确定1000多名慢性下腰痛患者的表型。本文报告了在面对面的下腰痛研究入组访视时获得的PROs关键信息和选定的人口统计学变量。 方法:下腰痛研究参与者完成了多项PROs,包括美国国立卫生研究院背痛研究工作组的最小数据集评估以及美国国立卫生研究院健康促进计划的通用数据元素。PROs被组织成五个概念领域:(1)疼痛特征和性质,(2)与疼痛相关的心理社会因素,(3)一般心理社会因素,(4)一般健康和生活方式因素,以及(5)健康的社会决定因素(SDoH)。还评估了患者对症状状态的接受程度,该评估由对关于10种症状中每种症状的水平是否令人满意的10个问题的“是/否”回答组成。 结果:从1007名慢性下腰痛的下腰痛研究参与者中收集了PRO测量数据。给出了在面对面入组访视时收集的PRO变量的均值和标准差,或中位数和四分位间距以及百分比,数据针对总体组,并按出生时性别(女性和男性)以及年龄(<60岁和≥60岁)分层。对于总体参与者以及不同性别和年龄组,疼痛强度和干扰平均处于中等水平。通过疼痛检测工具评估的神经性疼痛在总体样本中占18%,在60岁以下人群中占22.5%。如PROMIS T分数所示,平均而言,疲劳、抑郁和焦虑症状、记忆力和注意力、自我效能感以及积极展望均在正常范围内。然而,PROMIS身体功能低于正常水平,T分数处于轻度至中度损伤范围内。当要求参与者对其在10个功能领域的症状状态的可接受性进行评分时,最常报告的不满意领域是:疼痛强度和干扰、身体功能、睡眠和疲劳。在健康的社会决定因素方面,近一半(44%)的参与者报告曾经历过创伤性事件。在总体组中,36%的人报告在支付食品、医疗和取暖等基本需求方面有困难,而60岁以下组中有51%的人报告有这种经济压力。 结论:慢性下腰痛观察队列的疼痛强度、疼痛对生活活动的干扰以及与疼痛相关的残疾程度处于中等水平。参与者报告的与疼痛相关的心理社会因素水平为轻度至中度,抑郁和焦虑等一般心理健康挑战相对较少。许多参与者报告有创伤性事件经历且目前面临经济困难。慢性下腰痛的PRO结果为慢性下腰痛患者的社区样本提供了参考值。

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本文引用的文献

[1]
Demographic and Biomedical Characteristics of an Observational Cohort With Chronic Low Back Pain: A Descriptive Analysis.

JOR Spine. 2025-7-14

[2]
Evaluating the STarTBack stratified treatment approach for low back pain: exploring study-level factors potentially explaining differences in results of studies - a literature review.

BMJ Open. 2024-6-25

[3]
Impacts of social determinants of health on chronic opioid therapy for chronic non-cancer pain.

Pain Manag. 2024-6-2

[4]
Predictors of response in PROMIS-global in a chronic low back pain specialty clinic: STarTBack and chronic overlapping pain conditions.

J Back Musculoskelet Rehabil. 2024

[5]
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Lancet. 2023-6-3

[6]
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Pain Med. 2023-7-5

[7]
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Pain Med. 2023-8-4

[8]
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Pain Med. 2023-8-4

[9]
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Eur Spine J. 2022-11

[10]
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Lancet. 2021-7-3

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