Croft P R, Papageorgiou A C, Ferry S, Thomas E, Jayson M I, Silman A J
University of Keel, School of Postgraduate Medicine, Industrial and Community Health Research Centre, Stoke-on-Trent, UK.
Spine (Phila Pa 1976). 1995 Dec 15;20(24):2731-7. doi: 10.1097/00007632-199512150-00015.
The present is a prospective population-based cohort study.
To determine whether psychologic distress in patients free of low back pain predicts future new episodes of such pain.
An associating between symptoms of depression and anxiety and low back pain has been described in cross-sectional studies. It is unclear whether this represents cause or effect or whether it is found only in chronic pain sufferers attending specialist clinics. There is a need to investigate this prospectively in the general population.
The study population was 4501 adults aged 18-75 years who responded to a questionnaire survey mailed to all those registered with two family practices in the United Kingdom. The survey inquired about low back pain during the previous month and included the 12-item General Health Questionnaire, a validated schedule for measuring psychologic distress in the general population. New episodes of low back pain during the 12 months after the survey were identified by two methods--continuous monitoring of all primary care consulters and a second postal survey at the end of the 12-month period to determine occurrences for which consultation had not been sought.
Among 1638 subjects free of current low back pain in the baseline survey, the likelihood of developing a new episode of nonconsulting low back pain was higher among those with General Health Questionnaire scores in the upper third of the range compared with the lower third (adjusted odds ratio, 1.8 [1.4, 2.4]). This could not be explained either by age and gender differences or by general physical health. The increased risk persisted when analysis was restricted to those who at baseline could not recall ever having had low back pain in the past and to those with full-time employment.
Symptoms of psychologic distress in individuals without back pain predict the subsequent onset of new episodes of low back pain. We calculate from these data that the proportion of new episodes of low back pain that might be attributable to such psychologic factors in the general population is 16%.
本研究为基于人群的前瞻性队列研究。
确定无下腰痛患者的心理困扰是否能预测未来此类疼痛的新发情况。
横断面研究描述了抑郁和焦虑症状与下腰痛之间的关联。尚不清楚这是因果关系，还是仅在就诊于专科诊所的慢性疼痛患者中存在。有必要在普通人群中进行前瞻性调查。
研究人群为4501名年龄在18 - 75岁的成年人，他们回复了邮寄给在英国两家家庭诊所登记的所有人的问卷调查。该调查询问了前一个月的下腰痛情况，并包括12项一般健康问卷，这是一种在普通人群中测量心理困扰的有效量表。通过两种方法确定调查后12个月内下腰痛的新发情况——对所有初级保健咨询者进行持续监测，以及在12个月末进行第二次邮寄调查，以确定未寻求咨询的发病情况。
在基线调查中无当前下腰痛的1638名受试者中，一般健康问卷得分处于范围上三分之一的人群发生未咨询下腰痛新发情况的可能性高于下三分之一人群（调整后的优势比为1.8 [1.4, 2.4]）。这既不能用年龄和性别差异解释，也不能用一般身体健康状况解释。当分析仅限于那些在基线时回忆不起过去曾有过下腰痛的人和全职工作的人时，风险增加仍然存在。
无背痛个体的心理困扰症状可预测随后下腰痛新发情况的发生。根据这些数据我们计算出，普通人群中可能归因于此类心理因素的下腰痛新发情况比例为16%。
