Influence of Pain on Depression and Quality of Life in Patients with Spinal Cord Injury

脊髓損傷患者疼痛為憂鬱及生活品質之影響

陳耀仁(Yao-Jen Chen) ； 陳竑曄(Hong-Ye Chen)

《台灣復健醫學雜誌》 42卷2期 (2014/06) Pp. 81-87

https://doi.org/10.6315/2014.42(2)02

摘要

目的：調查脊髓損傷患者出現疼痛之盛行率，以及疼痛對脊髓損傷患者之憂鬱及生活品質之影響。方法：研究以問卷方式，請226位脊髓損傷患者完成問卷調查，問卷內容包含人口統計相關資料、脊髓損傷患者之臨床特徵、疼痛嚴重度、以中文版ID疼痛問卷評估有無神經性疼痛、以台灣人憂鬱問卷（TDQ）評估憂鬱狀況及以台灣版SF－36評估脊髓損傷患者之生活品質，並詢問患者使用藥物減低疼痛之頻率及其效果。患者以疼痛嚴重度分成無痛或輕微疼痛、中等程度疼痛及嚴重疼痛三組，並依據患者之臨床變項、憂鬱狀況及生活品質，比較三組間之不同。結果：完成完整問卷之比率為59.2%。脊髓損傷患者疼痛盛行率為85.0%，其中41.2%為嚴重疼痛。具有神經性疼痛性質之患者，有較高之疼痛度。年齡、性別、婚姻狀態、就業有無、教育程度、發病多久及脊椎受傷位置，不會影響疼痛嚴重度。疼痛嚴重度與台灣人憂鬱問卷分數，具有正向統計相關性。疼痛嚴重度只影響SF－36中的身體疼痛及社會功能兩項。TDQ之憂鬱分數，則影響SF－36所有分項之分數。大部分患者（86.2%），認為以藥物減輕疼痛只有些許效果或完全無效。結論：脊髓損傷患者疼痛盛行率很高。疼痛嚴重度與憂鬱狀態，具有正向統計相關性。疼痛嚴重度只影響SF-36中的身體疼痛及社會功能兩分項。憂鬱則影響SF－36所有分項之生活品質分數。大部分患者認為以藥物減輕疼痛，只有些許效果或完全無效，未來必須對脊髓損傷患者疼痛 ，做深入之研究以獲得有效之治療。

關鍵字

脊髓損傷 ； 疼痛 ； 憂鬱 ； 生活品質

並列摘要

Objective: To assess pain prevalence in a spinal cord injury (SCI) population and the influence of pain on depression and quality of life in patients with SCI. Methods: Two hundred twenty six SCI patients were asked to participate in this study after completing a questionnaire. The questionnaire included demographic data, clinical characteristics of SCI, performance of daily activities and pain intensity on a Numerical Rating Scale (NRS). The Chinese version of Identification (ID) of pain questionnaire was used to detect the neuropathic form of pain. The Taiwanese Depression Questionnaire (TDQ) was used for screening of depression and the Taiwan version of the 36-Item Medical Outcomes Short-Form Health (SF-36) for quality of life. Patients' attitude to the effect of pain medications was also asked. Patients were divided into those having mild pain, those having moderate pain and those having severe pain. These three groups of patients were compared according to clinical variables, depression scale and quality of life. Results: The response rate was 59.2%. The prevalence of pain after SCI was 85.0%. Of them, 41.2% reported severe pain. Patients with neuropathic pain had higher scores of pain (NRS, 6.86±2.21). Age, sex, marriage, employment status, education, and duration/level of injury did not influence pain intensity. Pain intensity was significantly associated with TDQ score. All scores of subgroups of SF-36 in the SCI population were lower than the general population. Only scores of bodily pain and social functioning domains of SF-36 were significantly influenced by pain intensity. Most of the patients (86.2%) with pain felt little or no effect of pain medications. Conclusion: Prevalence of pain after SCI is high. Intensity of pain is significantly correlated with depression. Patients with neuropathic pain had higher intensity of pain than patients with non-neuropathic pain. SCI patients had decreased scores in all domains of SF-36 but intensity of pain had a significant influence on domains of bodily pain and social functioning only. However depression had a significant influence on all domains of SF-36. In SCI patients with pain, most of them felt little or no relief from pain medications and most of them disliked taking pain medications. There is need for further study for an effective strategy for pain after SCI.

並列關鍵字

spinal cord injury ； pain ； depression ； quality of life