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Article(id=1321170158517867450, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170080579301694, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145112, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1717344000000, receivedDateStr=2024-06-03, revisedDate=1727107200000, revisedDateStr=2024-09-24, acceptedDate=1731945600000, acceptedDateStr=2024-11-19, onlineDate=1792921111945, onlineDateStr=2026-10-25, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921111945, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921111945, creator=13701087609, updateTime=1792921111945, updator=13701087609, issue=Issue{id=1321170080579301694, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='1', pageStart='1', pageEnd='128', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921093363, creator='13701087609', updateTime=1792921093363, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=27, endPage=31, ext={EN=ArticleExt(id=1321170158719194043, articleId=1321170158517867450, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Prevalence of diabetes mellitus among middle-aged and elderly patients with chronic pain in three provinces and municipalities of China, columnId=1320427696342020970, journalTitle=Chinese Journal of Public Health, columnName=Epidemiological Research, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the prevalence of diabetes mellitus among middle-aged and elderly patients with chronic pain in Beijing city, Jiangxi province, and Chongqing city, China, and to provide a reference for the development and improvement of pain management strategies for this population.

Methods

From January to August 2023, a multi-stage stratified random sampling method combined with convenience sampling was used to recruit 4320 outpatients aged ≥45 years with self-reported pain duration >3 months from six tertiary and six secondary general hospitals in Beijing city, Jiangxi province, and Chongqing city. A questionnaire survey was conducted to analyze the prevalence of diabetes mellitus among middle-aged and elderly patients with chronic pain, the influencing factors of pain intensity, and the factors that alleviate or exacerbate pain, as well as treatment status.

Results

Among the 4 151 middle-aged and elderly patients with chronic pain finally included in the analysis from the three provinces/cities, 736 had diabetes mellitus, with a prevalence of 17.7%. Among the 736 patients with chronic pain and diabetes mellitus, 163 (22.1%) had mild pain, 441 (59.9%) had moderate pain, and 132 (17.9%) had severe pain. Multivariable ordinal logistic regression analysis showed that living in rural areas, strenuous physical activity, having other medical histories, and having depressive symptoms were risk factors for increased pain intensity in patients with chronic pain and diabetes mellitus. Common pain-relieving factors for patients with diabetes mellitus were bed rest (60.9%), rest days (47.0%), and appropriate massage (38.3%), while aggravating factors were physical fatigue (59.8%), inappropriate exercise (44.8%), and prolonged sitting (35.2%). A total of 672 patients with chronic pain and diabetes mellitus received pain treatment, with a treatment rate of 91.3%. Common pain treatment methods included topical medications (61.9%), oral analgesics (55.1%), and moderate rest (48.7%).

Conclusions

The prevalence of diabetes mellitus among patients with chronic pain is high. Patients with diabetes mellitus living in rural areas, with other medical histories, engaging in strenuous physical activity, and experiencing depressive symptoms are more likely to experience increased pain. Moderate rest and appropriate exercise can effectively alleviate pain in patients with diabetes mellitus.

, authors=Mengyao CAO, Chengxin DU, Lin ZHU, Weiwei ZHANG, Liuxia YAN, Yingying JIANG, Jianqun DONG, authorsList=Mengyao CAO, Chengxin DU, Lin ZHU, Weiwei ZHANG, Liuxia YAN, Yingying JIANG, Jianqun DONG, authorCompany=null, correspAuthors=Jianqun DONG, authorNote=null, correspAuthorsNote=
DONG Jianqun, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321170159126041532, articleId=1321170158517867450, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=中国三省市中老年慢性疼痛患者合并糖尿病流行现状调查, columnId=1320427696509793132, journalTitle=中国公共卫生, columnName=流行病学研究, runingTitle=null, highlight=null, articleAbstract=
目的

了解中国北京市、江西省和重庆市三省市中老年慢性疼痛患者合并糖尿病的流行现状，为制定和完善该人群的疼痛管理方案提供参考依据。

方法

于2023年1—8月采用多阶段分层随机抽样结合方便抽样方法在北京市、江西省和重庆市抽取的6家三级甲等综合医院和6家二级甲等综合医院中招募4 320例≥45岁且主诉疼痛时间>3个月的门诊慢性疼痛患者进行问卷调查，分析中老年慢性疼痛患者合并糖尿病的流行现状及其疼痛程度的影响因素以及疼痛缓解、加重因素和治疗情况。

结果

中国三省市最终纳入分析的4 151例中老年慢性疼痛患者中，合并糖尿病者736例，慢性疼痛合并糖尿病患者比例为17.7%；736例慢性疼痛合并糖尿病患者中，轻度疼痛者163例（22.1%），中度疼痛者441例（59.9%），重度疼痛者132例（17.9%）；多因素有序logistic回归分析结果显示，居住在农村、重体力活动、有其他疾病史和有抑郁症状是慢性疼痛合并糖尿病患者疼痛程度加剧的危险因素；糖尿病患者常见的疼痛缓解因素为卧床休息（60.9%）、休息日（47.0%）和适当的按摩（38.3%），加重因素为身体疲劳（59.8%）、运动不当（44.8%）和久坐（35.2%）；有672例慢性疼痛合并糖尿病患者接受了疼痛治疗，接受疼痛治疗比例为91.3%；常见的疼痛治疗方式为使用局部外用药（61.9%）、口服止痛药（55.1%）和适度休息（48.7%）。

结论

慢性疼痛合并糖尿病患者比例较高，其中居住在农村、有其他疾病史、重体力活动和有抑郁症状的糖尿病患者疼痛加剧的可能性更高；适度休息和科学运动可有效缓解糖尿病患者的疼痛。

, authors=曹梦瑶, 杜成欣, 朱林, 张伟伟, 颜流霞, 姜莹莹, 董建群*, *, authorsList=曹梦瑶, 杜成欣, 朱林, 张伟伟, 颜流霞, 姜莹莹, 董建群, authorCompany=null, correspAuthors=董建群, authorNote=

曹梦瑶（1998—），硕士在读，研究方向：慢性病预防与控制

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董建群，E-mail：
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曹梦瑶（1998—），硕士在读，研究方向：慢性病预防与控制

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曹梦瑶（1998—），硕士在读，研究方向：慢性病预防与控制

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Pain, 2001, 94(2): 149-158., articleTitle=null, refAbstract=null), Reference(id=1321170162754114552, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=10, rfOrder=9, authorNames=null, journalName=null, refType=null, unstructuredReference=Li Y Z, Teng D, Shi X G, et al. Prevalence of diabetes recorded in China′mainland using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. The BMJ, 2020, 369: m997., articleTitle=null, refAbstract=null), Reference(id=1321170162817029113, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=11, rfOrder=10, authorNames=null, journalName=null, refType=null, unstructuredReference=中华医学会糖尿病学分会神经并发症学组. 糖尿病神经病变诊治专家共识(2021年版)[J]. 中华糖尿病杂志, 2021, 13(6): 540-557., articleTitle=null, refAbstract=null), Reference(id=1321170162884137978, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=12, rfOrder=11, authorNames=null, journalName=null, refType=null, unstructuredReference=杜成欣, 董建群, 颜流霞, 等. 神经病理性疼痛患者的自我管理: 定义、要素与展望[J]. 中国慢性病预防与控制, 2023, 31(9): 702-705., articleTitle=null, refAbstract=null), Reference(id=1321170162963829755, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=13, rfOrder=12, authorNames=null, journalName=null, refType=null, unstructuredReference=刘婧楠, 郑茹, 姜学文, 等. 北京事业单位女性颈肩、上背部疼痛现状及工作相关因素分析[J]. 中国公共卫生, 2021, 37(2): 275-279., articleTitle=null, refAbstract=null), Reference(id=1321170163039327228, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=14, rfOrder=13, authorNames=null, journalName=null, refType=null, unstructuredReference=医师报讯. 首个《我国五区域疼痛领域调研报告》公布[EB/OL]. (2023-10-19)[2024-03-20]. https://www.peopleapp.com/rmharticle/30003303419., articleTitle=null, refAbstract=null), Reference(id=1321170163114824701, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=15, rfOrder=14, authorNames=null, journalName=null, refType=null, unstructuredReference=金漂飘, 张雨晗, 于恩彦. 慢性疼痛和抑郁障碍共病机制的研究进展[J]. 浙江临床医学, 2023, 25(4): 622-624., articleTitle=null, refAbstract=null), Reference(id=1321170163173544958, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=16, rfOrder=15, authorNames=null, journalName=null, refType=null, unstructuredReference=Zis P, Daskalaki A, Bountouni I, et al. 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The association between leisure-time physical activity, sedentary behavior, and low back pain: a cross-sectional analysis in primary care settings[J]. Spine, 2021, 46(9): 596-602., articleTitle=null, refAbstract=null), Reference(id=1321170163353899008, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=19, rfOrder=18, authorNames=null, journalName=null, refType=null, unstructuredReference=Lima L V, Abner T S S, Sluka K A. Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena[J]. The Journal of Physiology, 2017, 595(13): 4141-4150., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1321170159348339645, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, xref=null, ext=[AuthorCompanyExt(id=1321170159360922558, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, companyId=1321170159348339645, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China), AuthorCompanyExt(id=1321170159369311167, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, companyId=1321170159348339645, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京 100050)])], figs=[ArticleFig(id=1321170161768453099, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, language=EN, label=Tab.1, caption=

Comparison of pain characteristics of chronic pain patients in different groups in three provinces and cities in China

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疼痛特征分类非糖尿病患者（N=3415）糖尿病患者（N=736）χ2值P值
人数占比/%人数占比/%
疼痛部位数（处）11 75651.438352.01.2330.540
283724.516722.7
≥382224.118625.3
膝关节疼痛无2 60076.149667.424.419<0.001
有81523.924032.6
脚踝部疼痛无3 22494.466790.614.751<0.001
有1915.6699.4
手部或足部疼痛无3 07690.164587.63.8740.049
有3399.99112.4
疼痛程度轻度疼痛91626.816322.122.563<0.001
中度疼痛209461.344159.9
重度疼痛40511.913217.9
疼痛频率不是每个月都有3329.77510.230.846<0.001
每月≥1次41312.1598.0
每周≥2次68220.011014.9
每天≥1次1 44242.233044.8
每时每刻54616.016222.0
疼痛导致失眠否2 12762.338852.723.207<0.001
是1 28837.734847.3
疼痛导致惊醒否2 46472.247564.516.981<0.001
是95127.826135.5
疼痛影响生活否1 36039.820728.135.268<0.001
是205560.252971.9
), ArticleFig(id=1321170161856533484, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, language=CN, label=表1, caption=

中国三省市不同组别慢性疼痛患者疼痛特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
疼痛特征分类非糖尿病患者（N=3415）糖尿病患者（N=736）χ2值P值
人数占比/%人数占比/%
疼痛部位数（处）11 75651.438352.01.2330.540
283724.516722.7
≥382224.118625.3
膝关节疼痛无2 60076.149667.424.419<0.001
有81523.924032.6
脚踝部疼痛无3 22494.466790.614.751<0.001
有1915.6699.4
手部或足部疼痛无3 07690.164587.63.8740.049
有3399.99112.4
疼痛程度轻度疼痛91626.816322.122.563<0.001
中度疼痛209461.344159.9
重度疼痛40511.913217.9
疼痛频率不是每个月都有3329.77510.230.846<0.001
每月≥1次41312.1598.0
每周≥2次68220.011014.9
每天≥1次1 44242.233044.8
每时每刻54616.016222.0
疼痛导致失眠否2 12762.338852.723.207<0.001
是1 28837.734847.3
疼痛导致惊醒否2 46472.247564.516.981<0.001
是95127.826135.5
疼痛影响生活否1 36039.820728.135.268<0.001
是205560.252971.9
), ArticleFig(id=1321170161936225261, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, language=EN, label=Tab.2, caption=

Comparison of pain intensity in patients with chronic pain and comorbid diabetes with different characteristics by gender, age, education level, rural/urban residence, smoking, alcohol consumption, physical activity level, history of other diseases and depressive symptoms in three provinces and cities in China

, figureFileSmall=null, figureFileBig=null, tableContent=
特征分类调查人数轻度疼痛中度疼痛重度疼痛Z/H值P值
人数占比/%人数占比/%人数占比/%
性别男性3287623.219960.75316.2–1.0680.286
女性4088721.324259.37919.4
年龄/岁45～591724626.710963.4179.9–2.9710.003
≥6056411720.733258.911520.4
文化程度初中及以下4649219.828962.38317.91.9130.384
高中/中专/技校1774626.09754.83419.2
大专及以上952526.35557.91515.8
居住地城市57314525.334059.38815.4–4.619<0.001
农村1631811.010162.04427.0
吸烟情况从不吸烟4759419.828960.89219.46.2950.043
现在吸烟1354130.47454.82015.9
曾经吸烟1262822.27861.92015.9
饮酒情况从未饮酒4429922.425657.98719.74.9740.084
饮酒但过去1个月内未饮酒1833116.912266.73016.4
饮酒且过去1个月内饮酒1113329.76365.81513.5
身体活动水平轻体力活动62813321.238160.711418.29.6360.008
中等体力活动902831.15156.71112.2
重体力活动18211.1950.0738.9
其他疾病史无842631.04958.3910.7–2.4710.013
有65213721.039260.112318.9
抑郁症状无65915723.839760.210515.9–4.600<0.001
有7767.84457.12735.1
), ArticleFig(id=1321170162036888558, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170158517867450, language=CN, label=表2, caption=

中国三省市不同特征慢性疼痛合并糖尿病患者疼痛程度比较

, figureFileSmall=null, figureFileBig=null, tableContent=
特征分类调查人数轻度疼痛中度疼痛重度疼痛Z/H值P值
人数占比/%人数占比/%人数占比/%
性别男性3287623.219960.75316.2–1.0680.286
女性4088721.324259.37919.4
年龄/岁45～591724626.710963.4179.9–2.9710.003
≥6056411720.733258.911520.4
文化程度初中及以下4649219.828962.38317.91.9130.384
高中/中专/技校1774626.09754.83419.2
大专及以上952526.35557.91515.8
居住地城市57314525.334059.38815.4–4.619<0.001
农村1631811.010162.04427.0
吸烟情况从不吸烟4759419.828960.89219.46.2950.043
现在吸烟1354130.47454.82015.9
曾经吸烟1262822.27861.92015.9
饮酒情况从未饮酒4429922.425657.98719.74.9740.084
饮酒但过去1个月内未饮酒1833116.912266.73016.4
饮酒且过去1个月内饮酒1113329.76365.81513.5
身体活动水平轻体力活动62813321.238160.711418.29.6360.008
中等体力活动902831.15156.71112.2
重体力活动18211.1950.0738.9
其他疾病史无842631.04958.3910.7–2.4710.013
有65213721.039260.112318.9
抑郁症状无65915723.839760.210515.9–4.600<0.001
有7767.84457.12735.1
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中国三省市中老年慢性疼痛患者合并糖尿病流行现状调查
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曹梦瑶 , 杜成欣 , 朱林 , 张伟伟 , 颜流霞 , 姜莹莹 , 董建群 *, *
中国公共卫生 | 流行病学研究 2025,41(1): 27-31
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中国公共卫生 |流行病学研究 2025 , 41 (1) : 27 -31
中国三省市中老年慢性疼痛患者合并糖尿病流行现状调查
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曹梦瑶（1998—），硕士在读，研究方向：慢性病预防与控制

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曹梦瑶, 杜成欣, 朱林, 张伟伟, 颜流霞, 姜莹莹, 董建群*, *
作者信息
  • 中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京 100050
通讯作者:
董建群，E-mail：
作者简介:

曹梦瑶（1998—），硕士在读，研究方向：慢性病预防与控制

Prevalence of diabetes mellitus among middle-aged and elderly patients with chronic pain in three provinces and municipalities of China
Mengyao CAO, Chengxin DU, Lin ZHU, Weiwei ZHANG, Liuxia YAN, Yingying JIANG, Jianqun DONG
Affiliations
  • National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China
    • Corresponding Author:
    DONG Jianqun, E-mail:
出版时间: 2025-01-10 doi: 10.11847/zgggws1145112
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摘要
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目的

了解中国北京市、江西省和重庆市三省市中老年慢性疼痛患者合并糖尿病的流行现状，为制定和完善该人群的疼痛管理方案提供参考依据。

方法

于2023年1—8月采用多阶段分层随机抽样结合方便抽样方法在北京市、江西省和重庆市抽取的6家三级甲等综合医院和6家二级甲等综合医院中招募4 320例≥45岁且主诉疼痛时间>3个月的门诊慢性疼痛患者进行问卷调查，分析中老年慢性疼痛患者合并糖尿病的流行现状及其疼痛程度的影响因素以及疼痛缓解、加重因素和治疗情况。

结果

中国三省市最终纳入分析的4 151例中老年慢性疼痛患者中，合并糖尿病者736例，慢性疼痛合并糖尿病患者比例为17.7%；736例慢性疼痛合并糖尿病患者中，轻度疼痛者163例（22.1%），中度疼痛者441例（59.9%），重度疼痛者132例（17.9%）；多因素有序logistic回归分析结果显示，居住在农村、重体力活动、有其他疾病史和有抑郁症状是慢性疼痛合并糖尿病患者疼痛程度加剧的危险因素；糖尿病患者常见的疼痛缓解因素为卧床休息（60.9%）、休息日（47.0%）和适当的按摩（38.3%），加重因素为身体疲劳（59.8%）、运动不当（44.8%）和久坐（35.2%）；有672例慢性疼痛合并糖尿病患者接受了疼痛治疗，接受疼痛治疗比例为91.3%；常见的疼痛治疗方式为使用局部外用药（61.9%）、口服止痛药（55.1%）和适度休息（48.7%）。

结论

慢性疼痛合并糖尿病患者比例较高，其中居住在农村、有其他疾病史、重体力活动和有抑郁症状的糖尿病患者疼痛加剧的可能性更高；适度休息和科学运动可有效缓解糖尿病患者的疼痛。

慢性疼痛  /  合并糖尿病  /  流行现状  /  中老年
Objective

To investigate the prevalence of diabetes mellitus among middle-aged and elderly patients with chronic pain in Beijing city, Jiangxi province, and Chongqing city, China, and to provide a reference for the development and improvement of pain management strategies for this population.

Methods

From January to August 2023, a multi-stage stratified random sampling method combined with convenience sampling was used to recruit 4320 outpatients aged ≥45 years with self-reported pain duration >3 months from six tertiary and six secondary general hospitals in Beijing city, Jiangxi province, and Chongqing city. A questionnaire survey was conducted to analyze the prevalence of diabetes mellitus among middle-aged and elderly patients with chronic pain, the influencing factors of pain intensity, and the factors that alleviate or exacerbate pain, as well as treatment status.

Results

Among the 4 151 middle-aged and elderly patients with chronic pain finally included in the analysis from the three provinces/cities, 736 had diabetes mellitus, with a prevalence of 17.7%. Among the 736 patients with chronic pain and diabetes mellitus, 163 (22.1%) had mild pain, 441 (59.9%) had moderate pain, and 132 (17.9%) had severe pain. Multivariable ordinal logistic regression analysis showed that living in rural areas, strenuous physical activity, having other medical histories, and having depressive symptoms were risk factors for increased pain intensity in patients with chronic pain and diabetes mellitus. Common pain-relieving factors for patients with diabetes mellitus were bed rest (60.9%), rest days (47.0%), and appropriate massage (38.3%), while aggravating factors were physical fatigue (59.8%), inappropriate exercise (44.8%), and prolonged sitting (35.2%). A total of 672 patients with chronic pain and diabetes mellitus received pain treatment, with a treatment rate of 91.3%. Common pain treatment methods included topical medications (61.9%), oral analgesics (55.1%), and moderate rest (48.7%).

Conclusions

The prevalence of diabetes mellitus among patients with chronic pain is high. Patients with diabetes mellitus living in rural areas, with other medical histories, engaging in strenuous physical activity, and experiencing depressive symptoms are more likely to experience increased pain. Moderate rest and appropriate exercise can effectively alleviate pain in patients with diabetes mellitus.

chronic pain  /  comorbid diabetes  /  prevalence  /  middle-aged and elderly people
曹梦瑶, 杜成欣, 朱林, 张伟伟, 颜流霞, 姜莹莹, 董建群. 中国三省市中老年慢性疼痛患者合并糖尿病流行现状调查. 中国公共卫生, 2025 , 41 (1) : 27 -31 . DOI: 10.11847/zgggws1145112
Mengyao CAO, Chengxin DU, Lin ZHU, Weiwei ZHANG, Liuxia YAN, Yingying JIANG, Jianqun DONG. Prevalence of diabetes mellitus among middle-aged and elderly patients with chronic pain in three provinces and municipalities of China[J]. Chinese Journal of Public Health, 2025 , 41 (1) : 27 -31 . DOI: 10.11847/zgggws1145112
正文
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随着中国人口老龄化趋势的加剧和生活方式的改变，慢性疼痛的发病率逐年上升，目前我国慢性疼痛患者>3亿人，且正以每年1 000～2000万的速度增长，慢性疼痛已成为影响中老年人生活质量的重要健康问题[1]。糖尿病作为一种中老年人群中常见的慢性代谢性疾病，在我国老年人群（≥60岁）中患病率已高达30%，患病数多达7813万[2]。研究表明，慢性疼痛与糖尿病高度共病，有近60 %的糖尿病患者受持续性疼痛的困扰[3]。糖尿病常见并发症之一是周围神经病理性疼痛[4]，亦可能加重原有疼痛，血糖或疼痛控制不佳往往引发患者的负面情绪，使其内分泌和机体免疫异常，从而引起血糖的进一步升高和疼痛的加剧，形成恶性循环[5]。为了解我国北京市、江西省和重庆市三省市中老年慢性疼痛患者合并糖尿病的流行现状，为制定和完善该人群的疼痛管理方案提供参考依据，本研究于2023年1—8月采用多阶段分层随机抽样结合方便抽样方法在北京市、江西省和重庆市抽取的6家三级甲等综合医院和6家二级甲等综合医院中招募4 320例≥45岁且主诉疼痛时间>3个月的门诊慢性疼痛患者进行问卷调查，分析中老年慢性疼痛患者合并糖尿病的流行现状及其疼痛程度的影响因素以及疼痛缓解、加重因素和治疗情况。结果报告如下。
1　对象与方法
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1.1　对象
采用多阶段分层随机抽样结合方便抽样方法，首先按照我国东部、中部和西部地域分布分别选取北京市、江西省和重庆市3个省市作为调查地区，其次在各省市分别随机抽取2个区（县、市）作为样本区（县、市），再次在每个样本区（县、市）分别随机抽取1家三级甲等综合医院和1家二级甲等综合医院作为样本医院，最后在抽取的6家三级甲等综合医院和6家二级甲等综合医院中招募年龄≥45岁的医院疼痛相关科室门诊就诊的疼痛持续时间>3个月的慢性疼痛患者作为调查对象进行问卷调查。本研究经中国疾病预防控制中心慢性非传染性疾病预防控制中心伦理委员会审查批准（批号：202301），且所有调查对象均签署了知情同意书。本次调查共发放4 320份问卷，实际回收有效问卷4 151份，问卷有效回收率为96.09%。
1.2　方法
采用自行设计调查问卷，由经过统一培训且考核合格的调查员进行面访调查。内容包括性别、年龄、文化程度、居住地、吸烟情况、饮酒情况、身体活动水平、是否糖尿病、有无其他疾病史、有无抑郁症状、慢性疼痛部位、疼痛程度、疼痛频率、疼痛对生活造成的影响、疼痛缓解和加重的原因、是否接受疼痛治疗和治疗的方式等。其中，吸烟情况通过询问调查对象“您现在吸烟吗？”进行调查，若回答“是的，每天吸”和“是的，但不是每天吸”，可判定为现在吸烟，若回答“以前吸，现在不吸”则判定为曾经吸烟[6]。身体活动水平中，如果工作时间中75%的时间是坐着的或站立的，25%的时间是站立活动的，属于轻体力活动；如果工作时间中25%的时间是坐着或站立的，75%的时间是从事特殊职业活动的，属于中等体力活动；如果工作时间中40%的时间是坐着的或站立的，60%的时间是从事特殊职业活动的，属于重体力活动[7]。糖尿病和其他疾病患病情况均由调查对象自报曾在二级及以上医疗机构确诊。采用患者健康问卷抑郁筛查量表（patient health questionnaire-2，PHQ-2）[8]评估调查对象近2周内的心理状况，该量表包括做事情时缺乏兴趣和乐趣以及情绪低落、抑郁或无望2个条目，每个条目按“完全没有”“≤7 d”“>7 d”和“几乎每天”分别赋0、1、2和3分，总分为0～6分，得分越高代表抑郁倾向越高，其中总分≥3分可判定为有抑郁症状。疼痛程度根据数字评定量表（numerical rating scale，NRS）0～10版[9]进行分级，该量表仅包含1个0～10分的点状标尺，分值越高代表疼痛程度越高，其中0分为无疼痛、1～3分为轻度疼痛、4～6分为中度疼痛、7～10分为重度疼痛。
1.3　统计分析
采用SPSS 26.0统计软件进行一般描述性分析、χ2检验、秩和检验和多因素有序logistic回归分析，以P<0.05为差异有统计学意义。
2　结　果
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2.1　一般情况
中国三省市最终纳入分析的4 151例中老年慢性疼痛患者中，男性1 803例（43.4%），女性2 348例（56.6%）；年龄45～59岁1 615例（38.9%），≥60岁2 536例（61.1%）；文化程度初中及以下2 568例（61.7%），高中/中专/技校962例（23.2%），大专及以上621例（15.0%）；居住在城市2 776例（66.9%），农村1 375例（33.1%）；从不吸烟2 819例（67.9%），现在吸烟702例（16.9%），曾经吸烟630例（15.2%）；从未饮酒2 674例（64.4%），饮酒但过去1个月内未饮酒820例（19.8%），饮酒且过去1个月内饮酒657例（15.8%）；轻体力活动3 204例（77.2%），中等体力活动739例（17.8%），重体力活动208例（5.0%）；无其他疾病史981例（23.6%），有其他疾病史3 170例（76.4%）；无抑郁症状3 773例（90.9%），有抑郁症状378例（9.1%）。
2.2　中国三省市有无糖尿病慢性疼痛患者疼痛特征比较（表1）
中国三省市最终纳入分析的4 151例中老年慢性疼痛患者中，合并糖尿病者736例，慢性疼痛合并糖尿病患者比例为17.7%；不同组别慢性疼痛患者比较，有无慢性疼痛2组糖尿病患者在有无膝关节疼痛、有无脚踝部疼痛、有无手部或足部疼痛、疼痛程度、疼痛频率、疼痛是否导致失眠、疼痛是否导致惊醒和疼痛是否影响生活方面差异均有统计学意义（均P<0.05）。
2.3　中国三省市慢性疼痛合并糖尿病患者疼痛程度影响因素分析（表2）
中国三省市不同特征慢性疼痛合并糖尿病患者疼痛程度比较，不同年龄、居住地、吸烟情况、身体活动水平及有无其他疾病史、抑郁症状糖尿病患者的疼痛程度不同，差异均有统计学意义（均P<0.05）。多因素有序logistic回归分析结果显示，居住在农村（OR=2.521，95%CI=1.748～3.636）、重体力活动（OR=3.201，95%CI=1.213～8.444）、有其他疾病史（OR=1.807，95%CI=1.120～2.917）和有抑郁症状（OR=2.903，95%CI=1.795～4.694）是慢性疼痛合并糖尿病患者疼痛程度加剧的危险因素。
2.4　中国三省市中老年慢性疼痛合并糖尿病患者疼痛缓解和加重原因以及疼痛治疗情况
中国三省市中老年慢性疼痛合并糖尿病患者主要的疼痛缓解因素为卧床休息[60.9%（448/736）]、休息日[47.0%（346/736）]和适当的按摩[38.3%（282/736）]，加重因素为身体疲劳[59.8%（440/736）]、运动不当[44.8%（330/736）]和久坐[35.2%（259/736）]。中国三省市最终纳入分析的4 151例中老年慢性疼痛患者中，有672例慢性疼痛合并糖尿病患者接受了疼痛治疗，接受疼痛治疗比例为91.3%；常见的疼痛治疗方式为使用局部外用药[61.9%（416/672）]、口服止痛药[55.1%（370/672）]和适度休息[48.7%（327/672）]。
3　讨　论
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本次调查结果显示，中国三省市中老年慢性疼痛患者合并糖尿病的比例为17.7%，高于依据美国糖尿病学会2018年糖尿病诊断标准的中国大陆地区成年人糖尿病患病率的12.8%[10]。本次调查中，糖尿病患者下肢疼痛较常见，且疼痛对睡眠的影响更大，这与糖尿病性周围神经病理性疼痛特点相似[4]。因此，为避免发展为糖尿病足甚至截肢，应对糖尿病患者进行及时的周围神经病变筛查[11]，在医护人员的指导下采取正确的治疗与控制措施以减缓周围神经病变发展进程[12]。
多因素有序logistic回归分析结果显示，居住在农村、重体力活动、有其他疾病史和有抑郁症状的中老年慢性疼痛合并糖尿病患者疼痛加剧的可能性更高，为疼痛管理需重点关注的人群。736例慢性疼痛合并糖尿病患者中，城市患者多于农村患者，但农村患者疼痛加剧的可能性是城市患者的2.521倍（OR=2.521，95%CI=1.748～3.636），这可能与本次调查对象为医院就诊患者有关，因城市地区较农村地区医疗资源和设施更为健全，因此城市居民更易主动就医，疼痛的控制及管理效果也就更好。有重体力活动的糖尿病出现的疼痛程度较高，这与对慢性肌肉骨骼疼痛研究得出的结果一致[13]。有其他疾病史的糖尿病患者疼痛程度高于无其他疾病史的糖尿病患者，这与《我国五区域疼痛领域调研报告》[14]提出的“疼痛与慢性病有关，慢病共病越多，疼痛风险越高，疼痛越升级”的观点一致。与金漂飘等[15]研究结果一致，抑郁也是疼痛程度加剧的危险因素，这可能是因为疼痛作为一种主观感受和体验，患者易产生负性情绪，因此在抑郁患者中，疼痛等躯体症状较为多见[16]。
作为慢性病的可改变影响因素，生活方式在健康管理中的作用不可小觑[17]。本次调查中，中老年慢性疼痛合并糖尿病患者认为疼痛加重的主要原因为“久坐”和“运动不当”，与相关研究[18–19]结果一致，提示缺乏运动和不科学的运动方式是疼痛加重的危险因素。2007年美国运动医学年会提出“Exercise is medicine（EIM）”的理念，即“运动是良医或良药”，该理念一经推出即得到运动及医学界的一致共识。因此，适度休息和科学运动可有效缓解糖尿病患者的疼痛。
综上所述，慢性疼痛合并糖尿病患者比例较高，其中居住在农村、有其他疾病史、重体力活动和有抑郁症状的糖尿病患者疼痛加剧的可能性更高，应将此类人群作为疼痛管理的重点关注人群，有针对性地进行疼痛监测和管理。依托移动医疗的管理方式有巨大的发展空间，其健康发展需要政府和社会的不断投入，提高医疗服务质量和水平。由于本次调查仅涉及北京市、江西省和重庆市3个省市的医院门诊，样本不能很好地代表中老年慢性疼痛人群，且本研究类型为横断面研究，结果只能表明某些因素与疼痛特点之间的关联而无法提供因果推论，因此本研究结果存在一定的局限性。在今后的研究中，可进一步收集更多地区数据并进行前瞻性队列研究对本研究结果加以论证。

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doi: 10.11847/zgggws1145112
  • 接收时间：2024-06-03
  • 首发时间：2026-10-25
  • 出版时间：2025-01-10
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  • 收稿日期：2024-06-03
  • 修回日期：2024-09-24
  • 录用日期：2024-11-19
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    中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京 100050

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