Flatø B, Aasland A, Vandvik I H, Førre O
Center for Rheumatic Diseases, OSR, National Hospital, Oslo, Norway.
Clin Exp Rheumatol. 1997 Sep-Oct;15(5):569-77.
The aim of the present study was to describe the outcome and determine predictors of persisting chronic idiopathic musculoskeletal pain in children.
A prospective 9-year follow-up of 37 children with musculoskeletal pain of at least 3 months duration for which no physical origin could be found, was carried out. The study comprised those patients with idiopathic pain in a cohort of 117 first admissions to a pediatric rheumatology clinic; 72 patients with juvenile chronic arthritis (JCA) were used as a comparison group.
Twenty-two patients (59%) still had chronic idiopathic musculoskeletal pain at the 9-year follow-up, while 15 patients no longer had pain after a median of 2.1 years (range 0.3-8.9). Compared with the patients with resolved pain, those with chronic pain had a longer disease duration before admission (median 1.4 versus 0.5 years, P < 0.01), more frequent generalised pain (86 versus 47%, P < 0.05), more intense pain (median 4.3 versus 0.5 cm VAS, P < 0.05), a lower parental education level (mean 10 versus 14 years, P < 0.01) and more chronic family difficulties (mean score 4.3 versus 2.9, P < 0.01) on first admission. Predictors of persistent pain were generalised pain on first admission (OR = 84) and a low mother's education level (OR = 0.31 per year of increased education). At follow-up, 16 patients (73%) with persistent chronic pain reported some disability according to the childhood or the adult Health Assessment Questionnaire (CHAQ/HAQ). The patients with chronic pain had as high a pain intensity (median 2.7 versus 2.0 cm VAS, NS), as much disability (median CHAQ/HAQ 0.3 versus 0.3) and as much impact on overall well-being (median 2.9 versus 3.2 cm VAS, NS) as patients with active JCA, but they had more fatigue (median 5.1 versus 1.3 cm VAS, P < 0.05), lower levels of psychosocial functioning (median score 74 versus 80, P < 0.05) and more chronic family difficulties (median score 3.3 versus 2.3, P < 0.001) than the JCA patients.
Chronic idiopathic musculoskeletal pain in children had an unfavourable outcome in the present study, especially in children with generalised pain and a low parental education level.
本研究旨在描述儿童持续性慢性特发性肌肉骨骼疼痛的结局，并确定其预测因素。
对37名肌肉骨骼疼痛持续至少3个月且未发现身体原因的儿童进行了为期9年的前瞻性随访。该研究纳入了117名首次入住儿科风湿病诊所的特发性疼痛患者；72名青少年慢性关节炎（JCA）患者作为对照组。
在9年随访时，22名患者（59%）仍患有慢性特发性肌肉骨骼疼痛，而15名患者在中位时间2.1年（范围0.3 - 8.9年）后不再疼痛。与疼痛缓解的患者相比，慢性疼痛患者入院前病程更长（中位时间1.4年对0.5年，P < 0.01），全身性疼痛更频繁（86%对47%，P < 0.05），疼痛更剧烈（中位视觉模拟评分4.3 cm对0.5 cm，P < 0.05），首次入院时父母教育水平较低（平均10年对14年，P < 0.01），慢性家庭困难更多（平均评分4.3对2.9，P < 0.01）。持续性疼痛的预测因素为首次入院时的全身性疼痛（比值比 = 84）和母亲教育水平低（每增加一年教育比值比 = 0.31）。在随访时，根据儿童或成人健康评估问卷（CHAQ/HAQ），16名（73%）持续性慢性疼痛患者报告有一定残疾。慢性疼痛患者的疼痛强度（中位视觉模拟评分2.7 cm对2.0 cm，无显著性差异）、残疾程度（中位CHAQ/HAQ 0.3对0.3）以及对整体幸福感的影响（中位视觉模拟评分2.9 cm对3.2 cm，无显著性差异）与活动期JCA患者相当，但他们比JCA患者更疲劳（中位视觉模拟评分5.1 cm对1.3 cm，P < 0.05），心理社会功能水平更低（中位评分74对80，P < 0.05），慢性家庭困难更多（中位评分3.3对2.3，P < 0.001）。
在本研究中，儿童慢性特发性肌肉骨骼疼痛结局不佳，尤其是全身性疼痛且父母教育水平低的儿童。
