Data_Sheet_2_Correlation Between Chronic Pain Acceptance and Clinical Variables in Ankylosing Spondylitis and Its Prediction Role for Biologics Treatment.PDF

Objectives: Studies have proven that improving patients' acceptance of chronic pain could be an effective therapy for alleviating pain and other symptoms. Our objectives were to investigate the correlation between chronic pain acceptance and clinical variables in ankylosing spondylitis (AS), and the prediction role of chronic pain acceptance for biologics treatment.
Methods: First, 167 AS patients were recruited to complete a series of questionnaires, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Chronic Pain Acceptance Questionnaire (CPAQ), Hospital Anxiety and Depression Scale (HADS), and Tampa Scale for Kinesiophobia (TSK). Bivariate correlation analysis was utilized to investigate the correlation between pain acceptance and clinical variables. Based on the level of chronic pain acceptance and serum C-reactive protein (CRP), patients were separated into four subgroups. Then, another 68 patients initiating anti-tumor necrosis factor (TNF) treatment were recruited to complete the questionnaires at baseline (T0) and 3 months after treatment (T3). The changes in clinical variables and treatment response were compared between multiple subgroups.
Results: Chronic pain acceptance had strong correlations with anxiety, depression and fear of movement, and moderate correlations with BASFI and pain intensity. Both activity engagement (AE) and pain willingness (PW) had significant correlations with pain intensity, BASFI and psychological status. In addition, AE had a significant correlation with disease duration, while PW had a significant correlation with ASDAS-CRP. Subgroup analysis showed that patients with low chronic pain acceptance and high levels of serum CRP had the highest BASDAI. Among patients initiating anti-TNF treatment, those with high pain acceptance and high levels of serum CRP achieved the most obvious reduction in BASDAI after 3 months treatment.
Conclusion: Pain acceptance is a new tool to assess pain in AS which may also reflect physical and psychological status. Clinicians should identify high-risk patients with low chronic pain acceptance and high levels of serum CRP, and give psychological and pharmacological intervention promptly. Moreover, the combination of baseline chronic pain acceptance and serum CRP level could be used to predict the treatment response in AS patients initiating biologics treatment.

研究目的：已有研究证实，提升慢性疼痛接受度可作为缓解疼痛及其他相关症状的有效治疗策略。本研究旨在探讨强直性脊柱炎（ankylosing spondylitis, AS）患者的慢性疼痛接受度与临床变量之间的相关性，以及慢性疼痛接受度对生物制剂治疗的预测价值。
研究方法：首先招募167名AS患者完成一系列问卷调查，包括巴斯强直性脊柱炎疾病活动指数（Bath Ankylosing Spondylitis Disease Activity Index, BASDAI）、巴斯强直性脊柱炎功能指数（Bath Ankylosing Spondylitis Functional Index, BASFI）、慢性疼痛接受问卷（Chronic Pain Acceptance Questionnaire, CPAQ）、医院焦虑抑郁量表（Hospital Anxiety and Depression Scale, HADS）以及塔姆帕运动恐怖症量表（Tampa Scale for Kinesiophobia, TSK）。采用双变量相关分析，探究疼痛接受度与临床变量的关联。依据慢性疼痛接受度水平与血清C反应蛋白（serum C-reactive protein, CRP），将患者划分为四个亚组。随后，招募68名初始接受抗肿瘤坏死因子（anti-tumor necrosis factor, anti-TNF）治疗的AS患者，分别在基线期（T0）与治疗3个月后（T3）完成上述问卷。比较不同亚组间的临床变量变化与治疗应答情况。
研究结果：慢性疼痛接受度与焦虑、抑郁及运动恐惧呈强相关，与BASFI及疼痛强度呈中等程度相关。疼痛行为投入（activity engagement, AE）与疼痛意愿（pain willingness, PW）均与疼痛强度、BASFI及心理状态存在显著相关性。此外，疼痛行为投入与疾病病程显著相关，而疼痛意愿与强直性脊柱炎疾病活动评分-C反应蛋白（ASDAS-CRP）显著相关。亚组分析显示，慢性疼痛接受度较低且血清CRP水平较高的患者，其BASDAI评分最高。在初始接受抗TNF治疗的患者中，慢性疼痛接受度较高且血清CRP水平较高的群体，在接受3个月治疗后BASDAI评分的改善最为显著。
研究结论：疼痛接受度是评估AS患者疼痛状况的新型工具，同时可反映患者的躯体与心理状态。临床医师应识别出慢性疼痛接受度低且血清CRP水平高的高危患者，并及时给予心理干预与药物治疗。此外，基线慢性疼痛接受度联合血清CRP水平，可用于预测初始接受生物制剂治疗的AS患者的治疗应答效果。