Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain

作     者：Kroenke, Kurt Outcalt, Samantha Krebs, Erin Bair, Matthew J. Wu, Jingwei Chumbler, Neale Yu, Zhangsheng 

作者机构：Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Indiana Univ Sch Med Dept Med Indianapolis IN 46202 USA Regenstrief Inst Hlth Care Indianapolis IN 46202 USA Minneapolis VA Hlth Care Syst VA HSR&D Ctr Chron Dis Outcomes Res Minneapolis MN USA Univ Minnesota Sch Med Minneapolis MN 55455 USA Indiana Univ Sch Med Dept Biostat Indianapolis IN 46202 USA Univ Georgia Coll Publ Hlth Dept Hlth Policy & Management Athens GA 30602 USA 

出 版 物：《GENERAL HOSPITAL PSYCHIATRY》 (综合性医院精神病学)

年 卷 期：2013年第35卷第4期

页      面：359-365页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：Department of Veterans Affairs Health Services Research and Development Merit Review award [IIR 07-119] Department of Veterans Affairs Health Services Research and Development Career Development Award [CDA2 07-215] 

主　　题：Anxiety Pain Quality of life Disability Comorbidity 

摘      要：Objective: Anxiety and chronic pain are prevalent and frequently co-occur. Our purpose was to examine the association between anxiety, health-related quality of life (HRQL) and functional impairment in primary care patients with chronic musculoskeletal pain. Methods: Data were drawn from baseline interviews of the 250 primary care patients enrolled in the Stepped Care to Optimize Pain care Effectiveness trial. Validated measures were used to determine the proportion of patients screening positive for five common anxiety disorders: generalized anxiety, panic, social anxiety, posttraumatic stress and obsessive-compulsive disorder. Bivariate analyses examined associations between the type and number of anxiety disorders for which patients screened positive and representative pain, psychological and other HRQL outcomes. Multivariable models controlling for major depression and other covariates examined the association between the number of screen-positive anxiety conditions and functional impairment in psychological [SF-12 mental component summary (MCS) score], pain [Brief Pain Inventory (BPI) interference score] and work (disability days) domains. Results: One hundred fourteen (45%) patients screened positive for at least one anxiety disorder and, compared to the 136 screen-negative patients, had significantly worse scores across multiple pain, psychological and other HRQL domains. Substantial impairment was seen for each of the five screen-positive anxiety conditions and progressively worsened as the number of conditions increased from one (n=54) to two (n=26) to = 3 (n=34). The number of screen-positive anxiety conditions was strongly associated (P.0001) with worse BPI interference and MCS scores and more disability days in models adjusting for age, sex and medical comorbidity. After further adjusting for major depression, associations were attenuated but remained significant for BPI interference (P.0001) and MCS (P=.018) and marginally significant for disability