高影响慢性疼痛患者长期缺勤的危险因素——一项范围审查和瑞典基于登记的队列研究。

IF 4 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Pain Pub Date : 2025-10-02 DOI:10.1016/j.jpain.2025.105570

Robin Larsson , Enisa Guta , Björn Äng , Riccardo LoMartire

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引用次数: 0

摘要

高影响性慢性疼痛（HICP）影响全球8%的人。除了其直接后果之外，HICP还增加了长期疾病缺勤（LTSA）的风险，导致收入损失和社会成本增加。预防是必不可少的，了解LTSA的风险因素是关键的第一步。我们进行了一项联合范围评估和瑞典基于登记的队列研究，首先确定并随后分析潜在的危险因素。一个多变量logistic回归模型估计了风险因素与LTSA之间的关联，LTSA定义为在专科医疗保健进入后的第三年里缺勤180天。似然比卡方检验确定了每个因素对模型拟合的贡献。以95%置信区间（95% CI）的边际风险比（mRR）报告相关性，比较第75至第25个样本百分位数。在确定的57个危险因素中，分析了10,552例患者样本中的34个，其中25%经历了LTSA。7个危险因素在Bonferroni-adjusted alpha水平上有显著影响：既往疾病缺病（mRR: 2.53; 95% CI: 2.40-2.66）、共病性神经疾病（1.60;1.38-1.81）、自评工作能力（1.42;1.29-1.58）、康复信心（1.21;1.13-1.30）、女性（1.18;1.10-1.26）、疼痛持续时间（1.11;1.03-1.20）和家庭收入，它们表现出复杂的非单调关系。与之前的研究一致，最强烈的关联是与之前的疾病缺勤有关。通过针对上述风险因素，可以促进HICP患者重返工作岗位。视角：我们的范围审查和瑞典基于登记的大样本研究确定并量化了高影响慢性疼痛患者长期缺勤的关键风险因素，为早期识别和有针对性的康复提供了基础，从长远来看，这可以支持劳动力重返社会，减少个人痛苦和社会成本。

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Risk factors for long-term sickness absence in patients with high-impact chronic pain – A scoping review and Swedish register-based cohort study

High-impact chronic pain (HICP) affects 8% of individuals worldwide. Beyond its direct consequences, HICP increases the risk of long-term sickness absence (LTSA), leading to income loss and increased societal costs. Prevention is essential and understanding risk factors for LTSA is a critical first step. We conducted a joint scoping review and Swedish register-based cohort study, to first identify and subsequently analyze potential risk factors. A multivariable logistic regression model estimated the association between the risk factors and LTSA, defined as >180 sickness absence days in the third year after specialist healthcare entry. The likelihood ratio chi-square test determined each factor’s contribution to model fit. Associations were reported as marginal risk ratios (mRR) with 95% confidence intervals (95% CI), comparing the 75th to the 25th sample percentiles. Of 57 identified risk factors, 34 were analyzed in a sample of 10,552 patients, 25% of whom experienced LTSA. Seven risk factors contributed significantly at a Bonferroni-adjusted alpha level: prior sickness absence, (mRR: 2.53; 95% CI: 2.40–2.66), comorbid neurological disorders (1.60; 1.38–1.81), self-rated work ability (1.42; 1.29–1.58), confidence in recovery (1.21; 1.13–1.30), female sex (1.18; 1.10–1.26), pain duration (1.11; 1.03–1.20), and household income, which showed a complex non-monotonic relationship. In line with previous research, the strongest association was with prior sickness absence. By targeting the aforementioned risk factors, workforce reintegration could be facilitated for individuals with HICP.

Perspective

Our scoping review and large sample Swedish register-based study identifies and quantifies key risk factors for long-term sickness absence in individuals with high-impact chronic pain, providing a foundation for early identification and targeted rehabilitation, which in the longer perspective could support workforce reintegration and reduce individual suffering and societal costs.

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来源期刊

Journal of Pain 医学-临床神经学

CiteScore

6.30

自引率

7.50%

发文量

441

审稿时长

42 days

期刊介绍： The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addition, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal. The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research.