Gatchel R J, Polatin P B, Mayer T G
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, USA.
Spine (Phila Pa 1976). 1995 Dec 15;20(24):2702-9. doi: 10.1097/00007632-199512150-00011.
An inception cohort design was used in which 421 patients were evaluated systematically with a standard battery of psychosocial assessment tests (Structured Interview for DSM-III-R Diagnosis, Minnesota Multiphasic Personality Inventory, and Million Visual Pain Analog Scale) within 6 weeks of acute back pain onset.
The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems (as measured by job-work status at 1-year follow-up evaluation).
There has been a relative paucity of prospective research in the United States comprehensively evaluating potential psychosocial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability. Such research has been quite limited because of the time and cost involved in conducting prospective studies.
All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks. These acute patients were tracked every 3 months, culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status.
Logistic regression analyses, conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury, revealed the importance of three psychosocial measures: self-reported pain and disability, scores on Scale 3 of the Minnesota Multiphasic Personality Inventory, and workers' compensation and personal injury insurance status. The model generated correctly classified 90.7% of the cases. Results revealed that major psychopathology, such as depression and substance abuse, did not precede or cause the development chronic pain disability.
These results show the presence of a robust "psychosocial disability factor" that is associated with those injured workers who are likely to develop chronic low back pain disability problems. Based on these data, a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability. The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability, although high rates of psychopathology have been shown in chronic low back pain. Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity.
采用初始队列设计，在421例患者急性背痛发作6周内，使用一系列标准的社会心理评估测试（《精神疾病诊断与统计手册》第三版修订本结构性访谈、明尼苏达多项人格调查表和百万视觉疼痛模拟量表）对其进行系统评估。
本研究评估了对社会心理和人格因素进行综合评估，在识别随后出现慢性疼痛残疾问题的急性下背痛患者方面的预测能力（通过1年随访评估时的工作状态来衡量）。
在美国，前瞻性研究相对较少，全面评估与那些因腰背痛残疾而在1年后未能重返工作岗位和恢复生产力的受伤工人相关的潜在社会心理风险因素。由于进行前瞻性研究涉及时间和成本，此类研究非常有限。
所有研究患者的腰椎疼痛综合征症状持续不超过6周。对这些急性患者每3个月进行一次跟踪，最终在初次评估1年后进行一次结构化电话访谈，以记录重返工作状态。
为区分1年后重返工作岗位的患者与因最初的背部损伤而未重返工作岗位的患者，进行了逻辑回归分析，结果显示三项社会心理指标的重要性：自我报告的疼痛和残疾情况、明尼苏达多项人格调查表第3分量表得分以及工伤赔偿和个人伤害保险状况。该模型正确分类了90.7%的病例。结果表明，诸如抑郁和药物滥用等主要精神病理学问题并非先于慢性疼痛残疾出现或导致其发生。
这些结果表明存在一个强大的“社会心理残疾因素”，它与那些可能会出现慢性下背痛残疾问题的受伤工人相关。基于这些数据，已生成一种统计算法，可识别出那些需要早期干预以预防慢性残疾发展的急性患者。第二个主要结果是，尽管慢性下背痛患者中精神病理学发生率较高，但受伤前或伴随的精神病理学似乎并不会使患者易患慢性疼痛残疾。未来的研究应针对受伤后可能导致慢性化的情绪易损性和社会心理事件。
