Hewitt D J, McDonald M, Portenoy R K, Rosenfeld B, Passik S, Breitbart W
Department of Neurology, Memorial Sloan-Kettering Cancer Center, Memorial Hospital, New York, NY 10021, USA.
Pain. 1997 Apr;70(2-3):117-23. doi: 10.1016/s0304-3959(96)03281-2.
Ambulatory AIDS patients participating in a quality of life study were recruited for an assessment of pain syndromes. Of 274 patients with pain, 151 (55%) consented to the assessment which included a clinical interview, neurologic examination, and review of medical records. The number, type, and etiology of pains were evaluated in terms of risk factors, age, sex, CD4+ lymphocyte count, and performance status. The average number of pains per patient was 2.7 (range, 1-7), yielding a total of 405 pains. The most common pain diagnoses were headache (46% of patients; 17% of all pains), joint pain (31% of patients; 12% of pains), pain due to polyneuropathy (28% of patients; 10% of pains), and muscle pain (27% of patients; 12% of pains). Pathophysiology was inferred for all pain syndromes (except for headache), 45% of pain syndromes were somatic in nature, 15% were visceral, 19% were neuropathic, and 4% were unknown, psychogenic, or idiopathic; 17% of pains were classified as headache, hence pathophysiology could not be determined. Pain resulted from diverse etiologies, including the direct effects of HIV/AIDS-related conditions (30%) pre-existing unrelated conditions (24%), and therapies for HIV/AIDS and related conditions (4%). The latter category, pain related to HIV therapies, occurred in 11% of patients. In 37% of the pains, the etiology could not be determined from the information available. In univariate analyses, lower CD4+ cell counts were significantly associated with polyneuropathy (P < 0.05) and headache (P < 0.05), and female gender was significantly associated with the presence of headache (P < 0.05) and radiculopathy (P < 0.001). These data confirm the diversity of pain syndromes in AIDS patients, clarify the prevalence of common pain types, and suggest associations between specific patient characteristics and pain syndromes. The large proportion of patients who could not be given a diagnosis underscores the need for a careful diagnostic evaluation of pain in this population.
参与一项生活质量研究的门诊艾滋病患者被招募来评估疼痛综合征。在274名有疼痛症状的患者中，151名（55%）同意接受评估，评估内容包括临床访谈、神经学检查以及病历审查。根据危险因素、年龄、性别、CD4+淋巴细胞计数和体能状态对疼痛的数量、类型和病因进行了评估。每位患者的平均疼痛数量为2.7（范围为1 - 7），共计405处疼痛。最常见的疼痛诊断为头痛（占患者的46%；占所有疼痛的17%）、关节痛（占患者的31%；占疼痛的12%）、多发性神经病变引起的疼痛（占患者的28%；占疼痛的10%）以及肌肉疼痛（占患者的27%；占疼痛的12%）。除头痛外，所有疼痛综合征的病理生理学均被推断，45%的疼痛综合征本质上是躯体性的，15%是内脏性的，19%是神经性的，4%是不明、心因性或特发性的；17%的疼痛被归类为头痛，因此无法确定其病理生理学。疼痛由多种病因引起，包括与HIV/AIDS相关病症的直接影响（30%）、先前存在的无关病症（24%）以及针对HIV/AIDS和相关病症的治疗（4%）。后一类与HIV治疗相关的疼痛发生在11%的患者中。在37%的疼痛中，根据现有信息无法确定病因。在单变量分析中，较低的CD4+细胞计数与多发性神经病变（P < 0.05）和头痛（P < 0.05）显著相关，女性性别与头痛（P < 0.05）和神经根病（P < 0.001）的存在显著相关。这些数据证实了艾滋病患者疼痛综合征的多样性，明确了常见疼痛类型的患病率，并表明特定患者特征与疼痛综合征之间的关联。很大一部分无法确诊的患者强调了对该人群疼痛进行仔细诊断评估的必要性。
