Bacon N M, Bacon S F, Atkinson J H, Slater M A, Patterson T L, Grant I, Garfin S R
Psychiatry Service, San Diego Veterans Affairs Medical Center, CA.
Psychosom Med. 1994 Mar-Apr;56(2):118-27. doi: 10.1097/00006842-199403000-00007.
Chronic low back pain (CLBP) patients often are described as "somatizers", who report multiple somatic complaints beyond back pain itself, but the nature and clinical significance of this observation is poorly understood. To clarify the characteristics, correlates and severity of somatization in CLBP, we rigorously assessed somatization symptoms in a sample of patients not selected for psychiatric or pain clinic referral. Male CLBP patients (N = 97), attending a primary care orthopaedic clinic, and matched healthy controls (N = 49), were assessed using the Diagnostic Interview Schedule III-A (DIS), Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HRSD), McGill Pain Questionnaire (MPQ), Sickness Impact Profile (SIP), and the Pain and Impairment Relationship Scale (PAIRS). Although none of the subjects met strict DSM-III criteria for a lifetime diagnosis of Somatization Disorder, 25.8% of CLBP patients reported a lifetime history of 12 or more somatic symptoms, as compared to only 4.1% of controls. In the less symptomatic ranges, patients still generally reported more symptoms than controls, with 51.5% of patients vs. 8.2% of controls reporting 7-11 symptoms, and 22.7% vs. 87.8% of controls reporting 0-6 symptoms (p < .001). Major depression and alcohol dependence were significantly associated with increased severity of somatization (p < .05). Lower mood and increased impairment, but not pain intensity, were related to greater number of somatic complaints. Symptoms of somatization are prevalent, but not universal, in CLBP and the pattern of these symptoms is reminiscent of the "spectrum of severity" reported in other medical populations. Recognizing this spectrum of somatization may lead to better patient-treatment matching and improved clinical outcomes.
慢性下腰痛（CLBP）患者常被描述为“躯体化者”，他们报告了除背痛本身之外的多种躯体不适，但这一现象的本质和临床意义却知之甚少。为了阐明CLBP患者躯体化的特征、相关因素及严重程度，我们对一组未因精神疾病或疼痛门诊转诊而入选的患者样本进行了严格的躯体化症状评估。对在初级保健骨科诊所就诊的男性CLBP患者（N = 97）和匹配的健康对照组（N = 49），使用诊断访谈表III - A（DIS）、贝克抑郁量表（BDI）、汉密尔顿抑郁评定量表（HRSD）、麦吉尔疼痛问卷（MPQ）、疾病影响量表（SIP）以及疼痛与功能障碍关系量表（PAIRS）进行评估。尽管没有受试者符合躯体化障碍终生诊断的严格DSM - III标准，但25.8%的CLBP患者报告有12种或更多躯体症状的终生病史，而对照组中这一比例仅为4.1%。在症状较轻的范围内，患者报告的症状仍普遍多于对照组，51.5%的患者报告有7 - 11种症状，而对照组为8.2%；22.7%的患者报告有0 - 6种症状，对照组为87.8%（p < 0.001）。重度抑郁和酒精依赖与躯体化严重程度增加显著相关（p < 0.05）。情绪低落和功能障碍增加，但疼痛强度并非如此，与更多的躯体不适相关。躯体化症状在CLBP患者中普遍存在，但并非全部如此，这些症状的模式让人联想到其他医学人群中报告的“严重程度谱”。认识到这种躯体化谱可能会实现更好的患者与治疗匹配，并改善临床结果。
