Macfarlane G J, Morris S, Hunt I M, Benjamin S, McBeth J, Papageorgiou A C, Silman A J
School of Epidemiology and Health Sciences, Department of Psychiatry and Behavioural Sciences, University of Manchester, UK.
J Rheumatol. 1999 Feb;26(2):413-9.
To determine whether psychological symptoms and mental disorder are an intrinsic part of the chronic widespread pain syndrome or whether they have been observed in clinic attenders primarily because of their influence on the decision to seek a medical consultation.
A population survey of 1953 subjects was conducted in the Greater Manchester area of the United Kingdom. The survey included a postal questionnaire, and in a subgroup of respondents with high levels of distress, the presence of mental disorder was assessed by a semistructured standardized interview. Subjects with chronic widespread pain were classified according to whether they had sought a medical consultation for the reported pain ("consulters") or not ("nonconsulters").
In all, 252 subjects (13%) satisfied American College of Rheumatology criteria for chronic widespread pain, and of these 72% reported having consulted a general practitioner about this pain. There was a clear difference in levels of psychological distress, measured by the General Health Questionnaire (GHQ), between consulters, nonconsulters, and those with no pain. Consulters did not differ from nonconsulters in terms of levels of fatigue, social dysfunction, or number of somatic symptoms reported. Although consulters (among whom one in 4 had a mental disorder) were more likely to have a mental disorder than subjects without pain [OR = 4.9, 95% CI (2.6, 9.5)] the increase in risk comparing consulters to nonconsulters [OR = 2.1, 95% CI (0.7, 5.9)] and nonconsulters to subjects without pain [OR = 1.4, 95% CI (0.7, 2.6)] was not significant.
The results suggest that psychological distress is associated with chronic widespread pain in addition to any effect on whether consultation is sought for symptoms. The finding that one-quarter of consulters to primary care with chronic widespread pain have a mental disorder should alert primary care physicians and rheumatologists to screen for mental disorder in this group.
确定心理症状和精神障碍是慢性广泛性疼痛综合征的内在组成部分，还是主要因为它们对寻求医疗咨询决定的影响而在门诊患者中被观察到。
在英国大曼彻斯特地区对1953名受试者进行了一项人群调查。该调查包括一份邮寄问卷，并且在苦恼程度较高的受访者亚组中，通过半结构化标准化访谈评估精神障碍的存在情况。患有慢性广泛性疼痛的受试者根据他们是否就所报告的疼痛寻求过医疗咨询（“咨询者”）或未寻求过（“非咨询者”）进行分类。
总共有252名受试者（13%）符合美国风湿病学会慢性广泛性疼痛标准，其中72%报告曾就该疼痛咨询过全科医生。通过一般健康问卷（GHQ）测量，咨询者、非咨询者和无疼痛者之间的心理苦恼水平存在明显差异。咨询者在疲劳程度、社会功能障碍或报告的躯体症状数量方面与非咨询者没有差异。尽管咨询者（其中四分之一患有精神障碍）比无疼痛的受试者更有可能患有精神障碍[比值比（OR）=4.9，95%置信区间（CI）（(2.6)，(9.5)）]，但将咨询者与非咨询者比较[OR = 2.1，95% CI（(0.7)，(5.9)）]以及非咨询者与无疼痛的受试者比较[OR = 1.4，95% CI（(0.7)，(2.6)）]时风险的增加并不显著。
结果表明，除了对是否因症状寻求咨询有任何影响外，心理苦恼与慢性广泛性疼痛有关。四分之一因慢性广泛性疼痛到初级保健机构咨询的患者患有精神障碍这一发现应提醒初级保健医生和风湿病学家对该群体进行精神障碍筛查。
