Hamilton Katrina R, Lukkahatai Nada, Chen Wanqi, Wu Hulin, Kawi Jennifer, Johnson Constance M, Christo Paul J, Campbell Claudia M
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
J Pain Res. 2025 Sep 5;18:4589-4598. doi: 10.2147/JPR.S523699. eCollection 2025.
A multimodal approach to clinical care is often recommended for chronic low back pain (cLBP); however, treatment responses are highly variable. Phenotyping could help determine subgroups of patients, allowing for targeted and tailored interventional approaches.
263 (Mage=69.8 (7.2); 64.6% female) individuals with cLBP participated in the parent study, a 3-arm, randomized clinical trial examining auricular point acupressure treatment outcomes. Parent study participants were randomized (1:1:1) to APA ear points targeted to cLBP (T-APA, n=92), non-targeted to cLBP (NT-APA, n=91), or education control (n=89). The current study used latent class analysis to identify clustering for pain severity (intensity, neuropathic pain) and pain impact (anxiety, depression, pain catastrophizing, fatigue, sleep disturbance) and determine if these classes were related to treatment outcomes (pain and disability reduction). Bayesian Information Criterion (BIC) was used for model selection. Post-LCA, ANOVA and Fisher's exact tests examined potential subgroup differences.
The three-class model emerged as the best fit due to relatively low BIC (-12105.46) and good patient distribution per class; class 1 n=79, class 2 n=109, class 3 n=75. Latent class 1 had moderate pain severity and pain impact, class 2 had high pain severity and pain impact, and class 3 had low pain severity and pain impact. No significant differences between classes were seen for age, sex, or BMI (p-value>0.05); however, latent class 3 had the highest physical functioning, lowest fear of physical activity, and disability, and significantly lower unemployment rate. There were no significant differences in treatment outcomes among the three classes.
Three distinct clusters of factors related to pain and psychological function for individuals with cLBP were found. These clusters align with previous work and add to the literature by providing important associations with demographic and clinical factors that have not been previously examined.
对于慢性下腰痛（cLBP），通常推荐采用多模式临床护理方法；然而，治疗反应差异很大。表型分析有助于确定患者亚组，从而采用有针对性的个性化干预方法。
263名（平均年龄=69.8岁（7.2岁）；64.6%为女性）cLBP患者参与了母研究，这是一项三臂随机临床试验，研究耳穴按压治疗效果。母研究参与者被随机分配（1:1:1）至针对cLBP的耳穴（T-APA，n=92）、不针对cLBP的耳穴（NT-APA，n=91）或教育对照组（n=89）。本研究使用潜在类别分析来确定疼痛严重程度（强度、神经性疼痛）和疼痛影响（焦虑、抑郁、疼痛灾难化、疲劳、睡眠障碍）的聚类情况，并确定这些类别是否与治疗结果（疼痛和残疾减轻）相关。贝叶斯信息准则（BIC）用于模型选择。潜在类别分析后，采用方差分析和费舍尔精确检验来检查潜在亚组差异。
由于相对较低的BIC（-12105.46）和各类别良好的患者分布，三类模型被认为是最佳拟合模型；第1类n=79，第2类n=109，第3类n=75。潜在类别1的疼痛严重程度和疼痛影响中等，类别2的疼痛严重程度和疼痛影响高，类别3的疼痛严重程度和疼痛影响低。在年龄、性别或体重指数方面，各类别之间未见显著差异（p值>0.05）；然而，潜在类别3的身体功能最高，对体育活动的恐惧和残疾程度最低，失业率显著较低。三类之间的治疗结果无显著差异。
发现了cLBP患者与疼痛和心理功能相关的三个不同聚类。这些聚类与先前的研究结果一致，并通过提供与以前未研究过的人口统计学和临床因素的重要关联，丰富了文献资料。
