广泛性疼痛：能否进行改进分类？

Widespread pain: is an improved classification possible?

作者信息

MacFarlane G J, Croft P R, Schollum J, Silman A J

机构信息

ARC Epidemiology Research Unit, University of Manchester, UK.

出版信息

J Rheumatol. 1996 Sep;23(9):1628-32.

PMID:8877936

Abstract

OBJECTIVE

The classification of widespread pain, proposed by the American College of Rheumatology (ACR) for use in the clinic as a screen for fibromyalgia, as described, does not require truly widespread pain. Studies considering the epidemiology of widespread pain per se may therefore require a definition with greater face validity, which might also show enhanced associations with other physical and psychological measures. We aimed to develop a more coherent definition of widespread pain for use in epidemiological studies and to compare performance in identifying individuals with significant morbidity.

METHODS

A group of 172 subjects who had participated in a community based study on the occurrence of pain were identified and categorized by their pain experience as indicated on line drawings of the body according to ACR definition and to a new, more stringent definition that required the presence of more diffuse limb pain. A number of other clinical and psychological measures were recorded for these individuals and the association between their pain status measures and these other variables was assessed and compared.

RESULTS

Persons satisfying the newly proposed definition for chronic widespread pain, in comparison with those who satisfied only the present ACR definition, had a significantly higher score on the General Health Questionnaire [median difference (MD) 7.95% CI 1.13], a higher score on the Health and Fatigue Questionnaire (MD 10.95% CI 0.15), and greater problems with sleep (sleep problem score MD 4.95% CI 0.9). Those satisfying the new definition also had a greater number of tender points on examination (MD 3.95% CI -1.7). The morbidity of those satisfying only the present ACR definition was closer to persons who had regional pain.

CONCLUSION

A redefinition of widespread pain has produced a group of subjects whose pain is (a) likely to be more "widespread" and (b) is associated more strongly with factors such as psychological disturbance, fatigue, sleep problems, and tender points, and may be more appropriate in epidemiological studies.

摘要

目的

美国风湿病学会（ACR）提出的广泛疼痛分类法，用于临床作为纤维肌痛的筛查方法，如前所述，并不要求真正的广泛疼痛。因此，考虑广泛疼痛本身流行病学的研究可能需要一个表面效度更高的定义，这也可能显示出与其他身体和心理测量指标有更强的关联。我们旨在为流行病学研究制定一个更连贯的广泛疼痛定义，并比较其在识别有显著发病率个体方面的表现。

方法

确定一组172名参与社区疼痛发生率研究的受试者，并根据身体线条图上他们的疼痛经历，按照ACR定义以及一个新的、更严格的定义（要求存在更弥漫的肢体疼痛）进行分类。记录这些个体的一些其他临床和心理测量指标，并评估和比较他们的疼痛状态测量指标与这些其他变量之间的关联。

结果

与仅符合当前ACR定义的人相比，符合新提出的慢性广泛疼痛定义的人在一般健康问卷上得分显著更高[中位数差异（MD）7.95%，置信区间1.13]，在健康与疲劳问卷上得分更高（MD 10.95%，置信区间0.15），睡眠问题更多（睡眠问题得分MD 4.95%，置信区间0.9）。符合新定义的人在检查时压痛点数也更多（MD 3.95%，置信区间 -1.7）。仅符合当前ACR定义的人的发病率更接近有局部疼痛的人。