Advances in research on the association between chronic pain and multidimensional frailty in the older adults
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摘要: 衰弱已经从单一强调身体衰弱发展为更为完善的涵盖身体衰弱、认知衰弱以及社会衰弱的多维度概念。慢性疼痛是一个全球性的公共卫生问题，严重影响老年人的生命质量。既往研究发现，慢性疼痛是导致老年人身体衰弱的一个重要危险因素。近年来，关于慢性疼痛与认知衰弱、社会衰弱的研究也逐渐增多。本研究系统梳理了老年人慢性疼痛与多维度衰弱的研究进展，总结归纳老年人慢性疼痛和多维度衰弱的评估方法，探究老年人慢性疼痛与多维度衰弱的相关性及其潜在作用机制，以期有助于老年人多维度衰弱早期预防及其干预，有效促进健康老龄化。Abstract: Frailty has evolved from a single concept emphasizing physical frailty to a multidimensional concept, including physical frailty, cognitive frailty, and social frailty. Chronic pain is a global public health issue that negatively impacts older adults′ life quality. Previous research has discovered that chronic pain is a significant risk factor for physical frailty in older adults. Studies on chronic pain, cognitive frailty, and social frailty have also increased in recent years. This study systematically reviews the progress of research on chronic pain and multidimensional frailty in older adults, summarizes the assessment methods of chronic pain and multidimensional frailty in older adults, and explores the correlation between chronic pain and multidimensional frailty in older adults and their potential mechanisms, with the aim of contributing to the early prevention of multidimensional frailty and its intervention in older adults, and effectively promoting healthy aging.
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Key words:
- Chronic pain /
- Physical frailty /
- Cognitive frailty /
- Social frailty
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表 1 慢性疼痛评估工具
Table 1. Chronic pain assessment tools
慢性疼痛评估工具 名称 特点 单维度疼痛评估工具 视觉模拟量表(visual analog scale, VAS)[13] (1)数字形式，连续数值，简便易行，在临床和科研工作中使用广泛 修订版Wong-Baker面部表情疼痛评估法(faces pain rating scale-revised, FPS-R)[14] (1)图像形式，直观，老年患者疼痛评估首选 数字评定量表(numeric rating scale, NRS)[15] (1)数字形式，分类明确，客观，可用于电话评估 口头评分法(verbal rating scale, VRS)[16] (1)文字形式，方便、快速评估，易于操作 多维度疼痛评估量表 简明疼痛量表(brief pain inventory, BPI-17)[17] (1)32条目，评估疼痛程度、性质、和对日常生活功能的影响；(2)适合科研调查，全面评估；(3)耗时长，需要医生专业指导 简明疼痛量表简表(brief pain inventory-short form, BPI-SF)[18] (1)9条目，评估疼痛程度、对日常生活功能的影响；(2)临床评估中最常用，全面简洁评估；(3)需要医生专业指导 麦吉尔疼痛问卷(McGill pain questionnaire, MPQ)[19] (1)22条目，评估疼痛性质、强度、情绪状态及心理感受等；(2)广泛使用于科研调查，可靠、有效；(3)问卷内容较复杂，耗费时间较长 简化McGill疼痛问卷(short-form of McGill pain questionnaire, SF-MPQ)[20] (1)15条目，评估疼痛强度、情绪状态等；(2)简洁，适用于检测时间有限但是又希望获得较多疼痛强度信息 整体疼痛评估量表(global pain scale, GPS)[21] (1)20条目，评估疼痛、情绪感受、临床表现、日常行为；(2)较好反映慢性疼痛患者近期的心理状态以及疼痛对其日常生活的影响等；(3)缺少对疼痛位置以及疼痛类型的评估 
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表 2 衰弱评估工具
Table 2. Frailty assessment tools
衰弱评估工具 名称 特点 身体衰弱评估工具 衰弱表型(frailty phenotype, FP)[22] (1)5条目，国内外临床和科研中应用最广泛[29]；(2)需采用专业工具，自我测评存在困难 FRAIL量表(fatigue, resistance, ambulation, illness, loss of weight, FRAIL)[30] (1)5条目，操作简便，是临床医生最优的筛查测试，能够快速进行身体衰弱筛查[30] 认知衰弱评估工具 简易精神状态检查(mini-mental state examination, MMSE)[31] (1)30条目，测评时间短，国内外应用最广泛的认知筛查量表[32]；(2)易受教育程度影响，对于轻度认知功能障碍敏感度低 蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)[33] (1)8条目，识别正常老年人与轻度认知障碍的敏感度明显优于MMSE，有较好的特异度[33]；(2)对于受教育程度较低者完成度及配合度降低 会衰弱评估工具 自陈式社会衰弱状态问卷[34] (1)5条目，易于理解，评分方便快捷 社会脆弱性指数[35] (1)40条目，连续数值，全面评估，能够实现数据间的可比性；(2)耗时较长 多维度衰弱评估量表 衰弱指数(frailty index, FI)[36] (1)流行病学研究应用较为广泛；(2)70条目，评估项目多且耗时长，需要专业人员进行综合评估 Tilburg衰弱量表(Tilburg frailty indicator, TFI)[37] (1)国内外应用较为广泛，社区老年人衰弱状况自评量表，测量方式更为灵活，评分简便；(2)15条目，涵盖生理、心理、社会衰弱3个维度 社区老年人群的综合衰弱评估量表修订版(comprehensive frailty assessment instrument plus, CFAI-Plus)[26] (1)35条目，涵盖身体、心理、社会、环境、认知衰弱5个维度，较为全面；(2)较为复杂，耗时较长，需要专业人员进行评估
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