Waltz M, Kriegel W, van't Pad Bosch P
Rheumatology Department, St. Willibrord Hospital, Emmerich, Germany.
Arthritis Care Res. 1998 Oct;11(5):356-74. doi: 10.1002/art.1790110507.
To examine prospective relations between a wide array of measures of social functioning and pain, while controlling for disease duration and activity and functional grade.
As part of a larger study on health care utilization, longitudinal data were collected from 136 Dutch and 98 German outpatients on clinical status and pain. Social data included information on sexual handicap, spouse behavior, loneliness, daily emotional support, and the maintenance of pleasurable life domains. Pain severity was assessed at baseline and 12 months later with standard measures of pain and analyzed with hierarchical regressions.
Social measures obtained at baseline were consistently associated with pain at followup. Depression was a moderate correlate of pain in the Dutch and German samples. The regressions revealed that patient reports of negative spouse behavior (such as avoidance and critical remarks) and baseline depression predicted worse pain outcome, and this association remained significant in analyses controlling for baseline pain. The level of formal education was a weak correlate of disability, emotional support, and pain. Daily emotional support and social life domains associated with positive affect had an indirect influence on outcome. The absence of strong rather than weak social ties was the component of the loneliness construct linked to pain. These associations between social prognostic factors and pain severity, however, were mediated by psychological functioning at baseline.
The social environment was found to operate on the core health outcome, pain severity, via several pathways. Social functioning may be affected by rheumatoid arthritis (RA) progression, but it also appears to form a determinant of future health outcome. Not only the status of being married but also the quality of the relationship in terms of long-term stress and emotional support may be useful prognostic factors in RA.
在控制疾病持续时间、活动度和功能分级的同时，研究一系列社会功能指标与疼痛之间的前瞻性关系。
作为一项关于医疗保健利用情况的大型研究的一部分，收集了136名荷兰和98名德国门诊患者的临床状况和疼痛的纵向数据。社会数据包括性障碍、配偶行为、孤独感、日常情感支持以及愉悦生活领域维持情况的信息。在基线和12个月后使用标准疼痛测量方法评估疼痛严重程度，并采用分层回归进行分析。
基线时获得的社会指标与随访时的疼痛始终相关。在荷兰和德国样本中，抑郁与疼痛呈中度相关。回归分析显示，患者报告的配偶负面行为（如回避和批评言论）以及基线抑郁预示着疼痛结局更差，并且在控制基线疼痛的分析中这种关联仍然显著。正规教育水平与残疾、情感支持和疼痛的相关性较弱。日常情感支持以及与积极情绪相关的社会生活领域对结局有间接影响。孤独感结构中与疼痛相关的部分是缺乏紧密而非薄弱的社会关系。然而，这些社会预后因素与疼痛严重程度之间的关联是由基线时的心理功能介导的。
发现社会环境通过多种途径影响核心健康结局——疼痛严重程度。社会功能可能受类风湿关节炎（RA）进展的影响，但它似乎也是未来健康结局的一个决定因素。不仅婚姻状况，而且从长期压力和情感支持方面来看的关系质量，可能都是RA中有用的预后因素。
