Coste J, Schiano P J, Leparc J M, Paolaggi J B
Service de rhumatologie, Hôpital Ambroise-Paré, Boulogne, France.
Rev Epidemiol Sante Publique. 1995;43(2):127-38.
This study aimed to explore the clinical and psychological features of non-specific low-back pain (LBP), and to evaluate a classification of patients based on the relationship between psychological disturbances and LBP clinical presentation. An unselected population of consecutive patients (n = 262) complaining of low-back pain to primary care physicians of the Epidemiology Team of the French Rheumatology Society, in October and November 1991, was studied. Measures included a standardized clinical evaluation of the back and a psychological assessment using the General Health Questionnaire. Ninety nine patients (38%) were classified as having a psychological disorder. The following symptoms: psychological precipitating event, permanent pain at night, diffuse spinal pain, pain increased by changing climate, pain increased by psychological factors, dysesthesias in the back, non-anatomical tenderness, were found to be closely associated with the existence of psychological disorder. Correspondence and cluster analyses provided support for the four-group classification of low-back pain previously devised. This classification may be interpreted through the relationships between psychological disturbances and the back clinical features. Although the study was mainly descriptive and used a cross sectional design, its results underline the importance of psychological influence on low-back pain presentation, and suggest the interest of a psychiatric assessment in low-back pain patients. Psychological disorders appear to be frequent in these patients and specific management of these disorders may prove useful.
本研究旨在探讨非特异性下腰痛（LBP）的临床和心理特征，并基于心理障碍与LBP临床表现之间的关系评估患者分类。1991年10月和11月，对向法国风湿病学会流行病学团队的初级保健医生主诉下腰痛的连续患者（n = 262）进行了一项无选择的研究。测量方法包括对背部进行标准化临床评估以及使用一般健康问卷进行心理评估。99名患者（38%）被归类为患有心理障碍。发现以下症状：心理诱发事件、夜间持续性疼痛、弥漫性脊柱疼痛、气候变化时疼痛加剧、心理因素导致疼痛加剧、背部感觉异常、非解剖学压痛，与心理障碍的存在密切相关。对应分析和聚类分析为先前设计的下腰痛四组分类提供了支持。这种分类可以通过心理障碍与背部临床特征之间的关系来解释。尽管该研究主要是描述性的且采用横断面设计，但其结果强调了心理因素对下腰痛表现的重要性，并表明对下腰痛患者进行精神科评估具有意义。心理障碍在这些患者中似乎很常见，对这些障碍进行特殊管理可能会被证明是有用的。
