带状疱疹后神经痛疼痛灾难化的影响因素分析

Analysis of influencing factors of post-herpetic neuralgia pain catastrophizing

目的 探讨带状疱疹后神经痛(post-herpetic neuralgia, PHN)患者疼痛灾难化(pain catastrophizing, PC)的影响因素。方法 选取2021年9月至2022年3月及2022年6月在上海第十人民医院门诊就诊的PHN患者,通过面对面询问的方式进行问卷调查。调查内容包括人口社会量表、PC量表(pain catastrophizing scale, PCS)、数字评价量表(numerical rating scale, NRS)、健康问卷抑郁症状群量表(patient health questionnaire-9, PHQ-9)和广泛性焦虑障碍量表(generalized anxiety disorde-7, GAD-7)等。结果 246例PHN患者参与问卷调查,其中男103例(41.9%),女143例(58.1%);年龄38~88岁,平均(69.4±9.7)岁;61.8%患者合并慢性病。PCS平均得分(26.04±12.54)分,其中反刍(9.72±4.64)分,无助(11.67±6.20)分,夸大(4.60±2.53)分;57例(23.2%)PCS得分≥38分。NRS平均得分(5.71±1.51)分,112例(45.5%)PHQ-9得分≥6分,77例(31.3%)GAD-7得分≥6分。多重线性回归分析结果显示,NRS得分、动态机械性痛觉超敏、PHQ-9及GAD-7得分是PCS得分的影响因素(P <0.05),其中动态机械性痛觉超敏对PCS得分影响最大,其次是NRS和GAD-7得分,PHQ-9得分对PCS得分影响最小。结论 PHN患者PC比例较高,疼痛强度越大、有动态机械性痛觉超敏、抑郁及焦虑情绪程度越重的患者,PC水平越高,临床应尽早给予该类患者心理干预,改善患者慢性疼痛结局。

Objective To explore the factors influencing pain catastrophizing(PC)in patients with post-herpetic neuralgia(PHN).Methods Patients with PHN admitted to Outpatient Department of Shanghai Tenth People's Hospital from September 2021 to March 2022 and June 2022 were selected.Questionnaires were conducted by face-to-face inquiry.The contents of the survey included demographic social scale,PC scale(PCS),numerical rating scale(NRS),patient health questionnaire-9(PHQ-9),generalized anxiety disorde-7(GAD-7).Results A total of 246 patients with PHN participated in the questionnaire,including 103(41.9%)males and 143(58.1%)females;the age ranged from 38 to 88 years old,with an average age of(69.4±9.7)years,61.8%of patients had chronic diseases.The average score of PCS was(26.04±12.54),including rumination(9.72±4.64)score,helplessness(11.67±6.20)score,and exaggeration(4.60±2.53)score.Fifty-seven(23.2%)patients had a PCS score≥38.The average score of NRS was(5.71±1.51),112(45.5%)patients had a PHQ-9 score≥6.Seventy-seven(31.3%)patients had a GAD-7 score≥6.Multiple linear regression analysis showed that NRS score,dynamic mechanical hyperalgesia,PHQ-9 and GAD-7 score were influencing factors of PCS score(P<0.05),in which dynamic mechanical hyperalgesia had the greatest impact on PCS score,followed by NRS score and GAD-7 score,and PHQ-9 score had the least impact on PCS score.Conclusions Patients with PHN have a higher proportion of PC.Patients with higher pain intensity,dynamic mechanical hyperalgesia,severe depression and anxiety have a higher level of PC.Patients should be given psychological interventions as early as possible to improve chronic pain outcomes.