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。
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.
