Using a biopsychosocial model of chronic radicular pain, we conducted a prospective study on the predictability of the therapy outcome in 41 lumbar disc patients from the Department of Neurology, University of Kiel. Before therapy, all patients had an extensive neurological and psychological examination. The criteria for the therapy outcome werepersistent pain and theduration of hospital stay in days. As for the psychological predictors, we examined the amount of depression as a state variable (Beck Depression Inventory BDI), depression as a trait variable (Giessen test), several paincoping modes (Hoppe scale) and the general health locus of control. As somatic predictors, we assessed the duration of pain before treatment, the number of previous operations, motoric paresis and the patient's age. The results indicated that the BDI was the best predictor of persistent pain and of the duration of hospital stay as well. The sensitivity and specificity were more than 90%. Patients with a BDI score >9 remained 8 days longer in the hospital than patients with lower BDI scores. In contrast to this, depression as a personality dimension allowed no correct prediction of patients with persistent pain. Thus, only the situational aspect of a depressive state is a relevant risk factor for chronicity. Overt pain behavior, avoidance behavior and fatalistic control expectations are the best predictors of persistent pain besides the BDI. Patients with persistent pain when discharged from the hospital had significantly more overt pain behavior preoperatively than patients without pain. They admitted that they changed their posture more often; they groaned, grimaced, or rubbed the painful area more often. Thus, these data confirm the operant conditioning theory of Fordyce within a prospective design. Furthermore, patients with strong avoidance behavior in pain situations and with fatalistic health expectations remained 8 to 10 days longer in the hospital. Regarding the somatic factors, only paresis is a significant predictor of these criteria. Patients with clear paresis showed more pain and a longer duration of hospital stay. In general, there was no significant correlation between the organic and psychological predictors, so independent psychological screening and the prospect of psychological interventions are necessary measures to prevent persistent pain in lumbar disc patients.

译文

使用慢性神经根痛的生物心理社会模型,我们对基尔大学神经病学系的41名腰椎间盘患者的治疗结果的可预测性进行了前瞻性研究。治疗前,所有患者都进行了广泛的神经和心理检查。治疗结果的标准是持续疼痛和住院天数。至于心理预测因子,我们检查了作为状态变量的抑郁量 (贝克抑郁量表BDI),作为特征变量的抑郁量 (吉森测验),几种疼痛应对模式 (霍普量表) 和总体健康控制源。作为躯体预测指标,我们评估了治疗前疼痛的持续时间,先前的手术次数,运动感觉和患者的年龄。结果表明,BDI是持续性疼痛和住院时间的最佳预测指标。敏感性和特异性均超过90%。BDI评分> 9的患者比BDI评分较低的患者在医院停留的时间延长了8天。与此相反,抑郁症作为人格维度,无法正确预测持续疼痛的患者。因此,只有抑郁状态的情境方面才是慢性病的相关风险因素。除BDI外,明显的疼痛行为,回避行为和宿命控制期望是持续性疼痛的最佳预测指标。出院后持续疼痛的患者术前明显比没有疼痛的患者明显更明显。他们承认他们更经常改变姿势; 他们更经常地呻吟、做鬼脸或摩擦痛苦的地方。因此,这些数据证实了预期设计中Fordyce的操作条件反射理论。此外,在疼痛情况下具有强烈回避行为且具有宿命论健康期望的患者在医院停留的时间延长了8至10天。关于躯体因素,只有瘫是这些标准的重要预测指标。患有明显的瘫的患者表现出更多的疼痛和更长的住院时间。总的来说,器质性和心理预测因子之间没有明显的相关性,因此独立的心理筛查和心理干预的前景是预防腰椎间盘突出症患者持续性疼痛的必要措施。

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