骨外傷後 精神社會因子可能預測持續性疼痛
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
June 2, 2010 — 根據一項發表於5月號疼痛期刊（The Journal of Pain）的研究結果，在非致命性急性骨外傷後，精神社會因子可能預測持續性疼痛的發生。
來自奧地利維也納Clayton Monash大學的Fiona J. Clay與其同事們寫到，早期偵測那些可能處於持續存在疼痛風險的患者是特別重要的，對於疼痛處理、以及可以長期回到工作的輔助系統也有相當的重要性。這項研究定量168位有著各式非危及生命骨外傷的疼痛患者，許多生物精神因子與持續性疼痛、疼痛嚴重度、以及干擾正常工作活動疼痛存在之間的關係。
這項研究收納至4家Victoria醫院其中1家接受外傷治療且於治療後觀察6個月的病患。以多變項分析受傷後6個月時預測疼痛預後的因子。
超過一半的受試者（54%）表示在6個月時有持續性疼痛，且大部份（87%）表示，這些疼痛會干擾他們的日常活動。疼痛預後的顯著獨立預測因子包括起始疼痛程度較高、損傷的外在責任歸屬、以及精神壓力。
疼痛相關的工作失能也顯著地預測預後期待較差，且疼痛嚴重度可以以工作時損傷顯著地預測。因為許多這些因子是潛在可以調整的，臨床醫師們應該知道這些因子且適當地介入，以避免病患發生慢性疼痛。
試驗作者們寫到，這項研究定量在急性骨外傷6個月後，疼痛的決定因子。精神社會因子強烈地預測持續性疼痛、疼痛相關的工作失能、以及疼痛嚴重度。這些發現可能協助臨床醫師們決定這個族群個人疼痛處理需求以及可能的效果。
這項研究的限制包括樣本數目較小、統計力量有限；缺乏對於疼痛位置數目或事件影響力的評量；以及使用單一根據36項短版健康調查問卷作為疼痛相關工作失能的評量。除此之外，外在責任歸屬的解釋並非根據已確效的指標。
研究作者們的結論是，這項研究的結果需要在較大型的研究、一致性更高的外傷族群中確認。針對醫院為主的內科治療、住院前後為主的復健、以及藥物使用，將可以讓我們了解這些因子在處理疼痛問題上的重要性。
交通運輸意外委員會與Monash大學畢業後學生基金贊助這項研究。Clay博士接受NHMRC公共衛生學者與VIC健康學者獎助。其餘試驗作者們表示沒有相關資金上的往來。
Psychosocial Factors May Predict Persistent Pain After Orthopaedic Trauma
By Laurie Barclay, MD
Medscape Medical News
June 2, 2010 — Psychosocial factors may predict persistent pain after non–life-threatening acute orthopaedic trauma, according to the results of a study reported in the May issue of The Journal of Pain.
"The early identification of those at risk of ongoing pain is of particular importance for injured workers and compensation systems for whom pain management and durable return to work are important outcomes," write Fiona J. Clay, from Monash University in Clayton, Victoria, Australia, and colleagues. "The study quantifies the association between a range of bio-psychosocial factors and the presence of persistent pain, pain severity and pain interfering with normal work activities in a cohort of 168 patients with a range of non-life-threatening orthopaedic injuries."
Patients presenting to 1 of 4 Victoria hospitals for treatment of their injury were recruited and were observed until 6 months after injury. Factors predicting pain outcomes at 6 months postinjury were identified with multivariate analysis.
More than half (54%) of participants reported having persistent pain at 6 months, and most (87%) reported having pain that interfered with their usual work activities. Significant independent predictors of pain outcomes were high levels of initial pain, external attributions of responsibility for the injury, and psychological distress.
Pain-related work disability was also significantly predicted by poor recovery expectations, and pain severity was significantly predicted by being injured at work. Because many of these factors are potentially modifiable, the clinician should be aware of them to be able to intervene appropriately to prevent the development of pain chronicity.
"This study has quantified determinants of pain, 6 months after non-life-threatening acute orthopaedic trauma," the study authors write. "Psychosocial factors strongly predicted persistent pain, pain-related work disability, and pain severity. These findings may assist clinicians to determine the need for, and likely effectiveness of, individual pain-management approaches in this population."
Limitations of this study include small sample size, limiting statistical power; lack of a measure of the impact of the event or of the number of pain sites; and use of a single item from the 36-item Short-Form Health Survey as a measure of pain-related work disability. In addition, the interpretation of external attributions of responsibility was not based on a validated scale.
"The results of this study need to be confirmed in larger studies and more homogenous injury populations," the study authors conclude. "An assessment of the extent of hospital-based medical treatment and pre- and post-hospital based rehabilitation and medication use would enable us to understand the importance of these factors in managing problems with pain."
The Transport Accident Commission and the Monash University Postgraduate Students Fund supported this study. Dr. Clay received a NHMRC Public Health scholarship and a VIC Health scholarship. The remaining study authors have disclosed no relevant financial relationships.
J Pain. 2010;11:420-430.
