臺灣博碩士論文加值系統

摘要
疼痛是影響老人生活品質的重要因素，一直以來國內缺乏此方向研究。本研究目的在了解社區老人慢性疼痛盛行率、疼痛型態、對生活影響及對疼痛採取之因應策略使用頻率、自覺效果及使用原因，並探討影響疼痛與因應策略之重要因素。研究採橫斷式研究設計，採多步驟隨機取樣方式以問卷針對219位台北市年滿65歲老人進行面對面訪問。研究結果發現：
一、社區老人慢性疼痛盛行率42.0%。老人疼痛部位以下背、下肢及膝部最多；疼痛原因以退化、骨質疏鬆、不確定及骨關節炎為多數，疼痛平均強度多為輕度(VAS < 4)及中度疼痛(VAS 4-6)，最大強度則以中度及重度疼痛(VAS > 6)最多。在92位有慢性疼痛問題的社區老人中，13.0%的老人表示幾乎24小時都痛；21.7%的老人每週疼痛次數大於7次，單次疼痛時間大於60分鐘者有17.4%。影響因素分析顯示女性、教育程度越低、有宗教信仰、無偶、自覺狀況越差者則出現慢性疼痛比率越高。就慢性疼痛發生機率而言，女性是男性的2.10倍，教育程度為國小者是其他教育程度的1.87倍，健康狀態每提高一單位，則慢性疼痛發生的機率減少0.53倍。
二、慢性疼痛對老人之整體生活影響程度普遍不大(mean = 20.36 ± 14.13, range 0-66)，但仍以走路及情緒影響最大，睡眠及日常生活活動影響最小，平均疼痛強度、最大疼痛強度、單次疼痛時間頻率是影響整體生活的主要因素(p<0.05)。最大疼痛強度與單次疼痛時間頻率則為整體生活影響程度最佳預測因子，共可解釋29.5%的總變異量。
三、針對慢性疼痛此一問題，老人傾向採取複向因應方式，平均使用過12.17項因應策略，且多為行為因應策略，對疼痛的因應策略方面，最常使用為坐下休息、輕揉或按摩、看西醫拿西藥。自覺效果最好者為泡溫泉、坐下休息、輕揉及按摩。但自覺效果佳者，並不一定是常使用者。策略之使用原因主依循過去疼痛經驗、親戚朋友告知及家人告知。至於主要影響慢性疼痛因應策略總數的因素有每次疼痛持續時間、整體生活影響程度。整體生活影響程度、單次疼痛持續時間、最大疼痛強度、平均疼痛強度為老人採取因應策略總數之最佳預測因子，可解釋25.1%變異量。
社區老人慢性疼痛的確是一個常見且主要的問題，至於社區老人的止痛策略是多層面及整合性的（不僅限於西方醫學模式，尚包括互補及另類療法），因此建議未來應增加老人及健康專業人員對整合性止痛因應策略的認知並可進行如互補及另類療法之介入效果評值性研究。對於慢性疼痛高危險族群，健康專業人員（如社區護士）應主動加以評估並提供預防策略；而對於已有慢性疼痛的老人，則應加強疼痛處置的危險性評估，並提供其較易接受及效果較好且安全的慢性疼痛因應策略，以增加處置的適當性與安全性，如此可增進老人之生活品質。

Abstract
Among many health problems of the elderly, chronic pain is a common but often ignored problem.The purpose of this cross-sectional study was to investigate the prevalence rate, pain patterns and coping strategies of chronic pain in Taipei community elderly. Two hundreds and nineteen community older persons were selected as population by a multiple stage random sampling. A structured-questionnaire was used to collect data by way of face to face interview. The main findings of this study showed as follow :
1.) The prevalence rate of chronic pain among the community elderly was 42.0%. The most common causes of chronic pain were osteoarthritis, osteoporosis and degeneration. Knees, low back and lower limbs were the pain sites often. For most subjects with a chronic pain ,the average pain intensity ranged from mild (VAS < 4) to moderate (VAS 4-6).Worst pain intensity fell in moderate and severe (VAS > 6). Among 92 subjects with chronic pain problem, thirteen percent of subjects had pain that prolonged all day long, 21.7% elders stated the times of pain for a week greater than 7 times, 17.4% elders expressed that it was more than 60 minutes for each pain. Female, low education, having religious belief, without a couple, and poor health status were high risk groups of chronic pain. According to a logistic regression analysis, female was 2.10 times to be more likely appeared chronic pain compared with male (odds ratio= 2.10), the elderly graduated from a elementary school was 1.87 time to other educational level (odds ratio= 1.87), for increasing one degree of health status, the odds ratio was 0.53.
2.) The impact of chronic pain on total daily life was not obvious (mean = 20.36 ± 14.13 , with a range from 0 to 66). Among seven dimensions of daily life, walking and emotion were affected most, sleeping and activity of daily life(ADL)were affected least. The average pain intensity , worst pain intensity and duration of pain for each time were significant statistically correlated to total daily life (p<0.05). Through a multiple regression analysis, it was found that the worst pain intensity, the frequency of pain were the optimal predicators of the impact on total daily life for the elders with chronic pain problems and accounted for total variation of 29.5%.
3.) Most elderly tended to use multi-dimensional coping strategies to relief their pain. The average number of coping strategies was 12.17. Elders used more behavioral coping strategies than cognitive strategies. Among thirty-eight coping strategies, sitting down, message and visiting a physician were often used by the elderly. The most effective coping strategies were hot spring, sitting and message. However, coping strategies which subjects used more frequently might not be more effective. The main reasons of the coping strategies used were according to personal previous experience, and introduction by friends and families. Duration of pain for each time and the impact on total daily life were significant correlated to the total number of coping strategies. According to multiple regression analysis, worst pain intensity, the average pain intensity, duration of pain for each time and the impact on daily life were the optimal predicators of the number of coping strategies. These four variables contributed for 25.1% of total variances.
In conclusion, this study supported that chronic pain was a popular and important problem for the community elders in Taiwan. Multi-dimensional and integrated coping strategies not only western medicine but including Complementary and Alternative medicine (CAM) were used to relief pain among the community elders. Hence, integrated coping strategies should be introduced to the elderly and health. professionals . An evaluative research of CAM should be conducted in the future. Health professionals (ex. community health nurse) should provide automatically the prevention of developing chronic pain, and assess automatically pain problem for the most elderly. For the elderly with a chronic pain, health professionals should provide more acceptable, effective, and safety coping strategies for reliefing pain and improving the quality of life.

第一章、研究動機與重要性 ---------------------------------------------------------- 1
第二章、文獻探討
第一節、老人疼痛的概念 ---------------------------------------------------------- 4
第二節、老人慢性疼痛盛行率、危險因子及影響 --------------------------- 15
第三節、老人疼痛因應策略方式及其效果 ------------------------------------ 19
第三章、研究設計
第一節、研究架構 ------------------------------------------------------------------- 33
第二節、名詞界定 ------------------------------------------------------------------- 34
第三節、研究目的、假設 ----------------------------------------------------------- 36
第四章、研究方法
第一節、研究對象 ------------------------------------------------------------------ 39
第二節、研究工具 ------------------------------------------------------------------- 46
第三節、研究步驟 ------------------------------------------------------------------ 49
第四節、倫理考量 ------------------------------------------------------------------ 52
第五節、資料分析方法 ------------------------------------------------------------- 53
第五章、研究結果
第一節、研究對象基本資料 ------------------------------------------------------ 55
第二節、社區老人之慢性疼痛盛行率、疼痛型態與影響因素-------------- 57
第三節、慢性疼痛對社區老人的生活影響及其相關因素 ------------------- 63
第四節、社區老人疼痛所採取的因應策略及其影響因素 ------------------- 66
第六章、討論
第一節、社區老人慢性疼痛盛行率、疼痛型態 ------------------------------- 76
第二節、慢性疼痛對社區老人的生活影響及其相關因素 ------------------- 80
第三節、社區老人疼痛所採取的因應策略及其影響因素 ------------------- 82
第七章、結論與建議
第一節、結論 ----------------------------------------------------------------------- 89
第二節、建議 ----------------------------------------------------------------------- 91
第三節、研究限制與建議 -------------------------------------------------------- 93
參考資料
中文參考資料 ----------------------------------------------------------------------- 94
英文參考資料 ----------------------------------------------------------------------- 98
附件一、專家效度名單 -------------------------------------------------------------------- 107
附件二、問卷同意書 ----------------------------------------------------------------------- 108
附件三、正式施測問卷 -------------------------------------------------------------------- 109
附件四、榮民總醫院臨床研究人體試驗委員會審核同意書 ----------------------- 117
圖表目錄
圖一、社區老人慢性疼痛盛行率、疼痛型態及其因應策略架構圖 -------------- 33
表4-1、母群體與調查樣本之比較 -------------------------------------------------------- 42
表4-2、拒訪與受訪老人個人因素檢定 ------------------------------------------------ 43
表4-3、拒訪與受訪老人個人因素比較 ------------------------------------------------- 44
表4-4、拒訪與受訪老人疼痛型態、生活影響程度及因應策略總數比較 ------- 44
表4-5、拒訪與受訪老人疼痛型態資料檢定 ------------------------------------------- 45
表5-1、研究樣本個人背景因素分析 ---------------------------------------------------- 56
表5-2、有無疼痛老人個人因素基數資料t檢定 -------------------------------------- 59
表5-3、疼痛老人疼痛型態資料 ---------------------------------------------------------- 59
表5-4、慢性疼痛發生與否之邏輯對數迴歸分析 -------------------------------------- 62
表5-5、疼痛老人生活影響層面 ---------------------------------------------------------- 63
表5-6、疼痛老人疼痛型態與疼痛總生活影響相關 ---------------------------------- 64
表5-7、慢性疼痛整體生活影響程度複迴歸分析表 ---------------------------------- 65
表5-8、疼痛個案因應策略頻率 ---------------------------------------------------------- 68
表5-9、疼痛個案慢性疼痛因應行為使用原因百分比 ------------------------------- 70
表5-10、影響社區老人慢性疼痛因應策略數目的相關因素 ------------------------- 72
表5-11、疼痛老人個人因素與慢性疼痛因應策略總數之相關性 ------------------ 73
表5-12、疼痛老人慢性疼痛型態與慢性疼痛因應策略數目檢定 ------------------ 74
表5-13、慢性疼痛因應策略數目逐步複迴歸分析表 ---------------------------------- 75

參考資料
中文文獻：
內政部統計處（2003，6月20日）．性別統計資料．內政部統計處網站．摘自http://www.moi.gov.tw/W3/stat/home.asp
王廷甫（1990）．台中地區居民中西醫療行為取向之研究．公共衛生，17(1)，21-33。
台北市政府主計處（2001，10月20日）．台北市人口之年齡分佈．台北市政府網站．摘自http://www.dbas.taipei.gov.tw/stat/abstract/Population.htm
台北市衛生局（2003，6月10日）．台北市醫院診所家數及病房數．台北市衛生局網站．摘自http://www.health.gov.tw
行政院衛生署（1998）．促進國民健康體能指引指導本．台北：行政院衛生署。
李梅琛（2000）．胃部手術後病患使用疼痛因應策略及其影響因素探討．國立台北護理學院護理研究所碩士論文。
李詩應（2001）．腰骨酸痛完全搞定(pp.28-29,63-65,104)．台北：原水文化出版，城邦文化發行。
邱瑞泉、朱美滿（1989）．經皮神經電刺激對急慢性疼痛止痛效果之比較．醫學研究，10(1)，39-44。
林光璋（1998）．台灣社區老人社會殘障率之研究．私立高雄醫學大學碩士論文。
林佳靜（1998）．癌症疼痛因應量表之發展與癌症疼痛因應行為之探討．護理研究，6(5)，405-415。
林智生、張家禎（2001）．慢性疼痛之臨床評估與處置．基層醫學，16(8)，199-203。
林梅香、顧乃平、劉仲冬、陳政友、林麗蟬（1996）．肝癌患者家屬主要照顧者的壓力、因應行為、健康狀況極其相關因素之探討．護理研究，4(2)，171-184。
林文香（1992）．為推展護理本土化奠石-認識民間醫療行為．榮總護理，9(2)，110-116。
吳明珠（2001）．肺部手術病患術後急性期疼痛經驗之探討．國立台北醫學院未發表碩士論文。
吳方瑜等合著（1996）．老人護理學．台北：匯華。
吳淑芳（1997）．脊椎損傷患者的不確定感、情緒安適與因應方式之相關性探討．國立陽明大學臨床護理研究所碩士論文。
孫維仁、侯文詠（1994）．慢性疼痛治療的新趨勢．醫學繼續教育，4(4)，463-470。
胡新實（1998）．下背痛．榮總護理，15(1)，30-40。
洪敏瑛（2000）．居家癌症患者對疼痛的因應策略與其相關因素探討．國立陽明大學社區護理研究所碩士論文。
徐翠霞（2001）．肺癌病患之疼痛程度與不確定感和希望狀態的相關性．國立台北護理學院護理研究所碩士論文。
徐南麗、王瑋、馮容莊、尹淑莉（1984）‧護理人力生產力之評估與應用‧護理研究1(2),101-111。
陳正生（2000）．社區老人憂鬱疾患之身體狀況．私立高雄醫學大學碩士論文。
陳淑卿（1999）．嚴重手部外傷病患之因應策略及其相關因素探討．私立台北醫學院護理學研究所碩士論文。
陳德人、毛家舫（2001）．另類醫療在健康照護體系的興起與趨勢．台灣醫界，44(9)，39-41。
黃經編著（1996）．實用內外科護理學（上）（下）．台北：華杏出版股份有限公司。
黃繼慶（1994）．社區支持系統對社區老人心理健康的影響．國立台灣大學碩士論文。
黃麗珍（2000）．社區獨居老人身體、心裡及社會功能之探討憂鬱疾患之身體狀況．私立高雄醫學大學碩士論文。
張苙雲（1998）．逛醫師的邏輯：求醫歷程的分析．台灣社會學刊，21，59-87。
張珣（1983）．台灣漢人的醫療體系與醫療行為—一個台灣北部農村的醫學人類學研究．中央研究院民族學研究所集刊，56，29-58。
葉春興（1992）．慢性疼痛與治療．臨床醫學，30(4)，246-251。
曾清楷（1999）．慢性疼痛症候群的描述和疼痛用語的定義．疼痛醫學雜誌，4，109-118。
楊美賞、曾清楷、鍾信心、葉宏軒（1992）．門診慢性疼痛病人日常生活功能及心理、社會功能障礙之評估．高雄醫學科學雜誌，8(10)，552-561。
楊文山（1992）．台灣地區民眾求醫行為之分析．榮總護理，9(2)，121-125。
楊靖宇、何善台（1991）慢性疼痛．國防醫學，12(1)，26-29。
楊靖宇、何善台（1994）非癌症慢性疼痛．國防醫學，18(3)，191-195。
蔡慶豐（1996）．如何戰勝腰酸背痛(pp.115)．台北：希代書版股份有限公司。
蔡麗雲（1995）．癌痛病患的心理困擾、疼痛因應策略及其相關因素之探討．國防醫學院護理研究所碩士論文。
鄭弘美（1999）．美國另類醫療發展現況．中西整合醫學雜誌，1(1)，39-43。
蔣欣欣、盧孳豔（1996）．健康與疾病的文化觀及現象分析．護理雜誌，43(4)，42-48。
賴裕和（1998）．簡易疼痛因應量表的發展與測試．未出版行政院國家科學委員會專題研究計畫成果報告．台北醫學院護理學研究所。
鄒秀菊（1994）．敬老院老人睡眠品質與健康狀況之探討．未出版的碩士論文，國防醫學院護理學研究所碩士論文。
鍾聿琳（2001）．護理人員對另類醫療應有的認識．台灣醫學，5(3)，343-347。
英文文獻：
Ali, N. S., & Khalil, H. Z.(1991) Identification of stressors, level of stress, coping strategies, and coping effectiveness among Egyptian mastectomy patients. Cancer Nursing,14(5), 232-239.
Anonymous(1998) American geriatric society clinical practice guidelines: the management of chronic pain in elder person. Geriatric, 53(suppl 3), S6-7.
Bernabei. R., Gambassi, G., Lapane, K. et al(1998) Management of pain in elderly patients with cancer. Journal of American medicine association. 279, 1877-1882.
Blyth, F. M., March, L. M., Brnabic, A-J. M., Jorm, L. R., Williamson, M., Cousins, M.(2001) Chronic pain in Australia: A prevalence study. Pain, 89, 127-134.
Brandt, K. D., Heilman, D. K., Slemenda, C., Katz, B. P., Mazzuca, S., Braunstein, E. M.& Byrd, D.（2000） A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain without radiographic evidence of knee osteoarthritis. Journal of rheumatology. 27(8), 1937-1946.
Brattberg, G. Thorslund, M., Wikman, A.(1989) The prevalence of pain in the general population: the result of a postal survey in a country of Sweden. Pain, 37(2). 215-222.
Buckelew SP. Shutty MS Jr. Hewett J. Landon T. Morrow K. Frank RG.(1990) Health locus of control, gender differences and adjustment to persistent pain. Pain,42(3),287-94.
Buono, M. D., Urciuoli, O., Marietta, P., Padoani, W., De Leo, D.(2001) Alternative medicine in a sample of 655 community-dewelling elderly. Journal of psychosomatic research, 50, 147-154.
Charlton, J.E., & Edwards, C.(1994) Pain. In R. Walker & C. Edwards (Eds.), Clinical Pharmacy and therapeutics(1st ed., pp.455-465).
Chesterton, L. S., Barlas, P., Foster, N. E., Baxter, G.. D., Wright, C. C.(2003) Gender differences in pressure pain threshold in health humans. Pain, 101(3), 259-266.
Cleeland, C. S. (1989). Assessment pain in cancer case: measurement issues. Advanced pain research therapy, 16(1), 47-55.
Cleeland, C. S. Gonin, R., Hatfield, A. K. et al (1994) Pain and its treatment in outpatients with metastatic cancer. New England journal medicine. 330, 592-6.
Cook, A., & Thomas, M.(1994) Pain and the use of health services among the elderly. Journal of aging and health, 16(2), 155-172.
Crook, J. R., Rideout, E., Browne, G..(1984) The prevalence of pain complains in a general population. Pain, 18, 299-314.
Dunkel-Schetter C., Feinstein LG. Taylor SE., Falke RL.(1992) Patterns of coping with cancer. Health Psychology. 11(2):79-87.
Evans, D. P., Brooke, M. S. Lloyd, K. N., Roberts, E. E., & Robert, G.M.(1978) Lumbar spinal manipulation on trial; Part I - clinical assessment. Rheumatic rehabilitation, 17, 46-53.
Fernandez E. Turk DC.(1989) The utility of cognitive coping strategies for altering pain perception: a meta-analysis. Pain. 38(2): 123-35.
Ferrell, B. A.(1991) Pain management in elderly people. American journal society. 39, 64-73.
Ferrell, B. A., Ferrell, B. R.(1989) Assessment of pain in the elderly. Geriatric med today. 8, 123-134.
Ferrell, B. A.(1995) Pain evaluation and management in the nursing home. Ann intern med. 123(9), 681-7.
Ferrell, B. A., Ferrell, B. R, Osterweil, D.(1990) Pain in the nursing home. Journal American Geriatric society. 38(4), 409-414.
Fisk, J. A.(1979) A controlled trial of manipulation in a selected group of patients with low back pain favouring one side. New Zealand journal medicine, 10, 288-291.
Forman, W.B., Stratton, M.(1991) Current approaches to chronic pain in older patients. Geriatrics, 46(7). 47-52.
Fowler, F. J. & Mangione, T. W.(1999) Standardized Survey〔標準化的調查訪問〕（黃朗文譯）. 台北：弘智文化事業有限公司（原著出版於1990）。
Freedman, G.. M.(2002) Chronic pain: clinical management of common causes of geriatric pain. Geriatrics, 57(5), 36-41.
Francesco, L., Graziano, O., Matteo, C., Giovanni, G., Knight, S., Andrea, R., Fabrizia, L., Roberto, B.(2001) Pain management in frail, community-living elderly patients. Arch international medicine, 161, 2721-2724.
Ger, L. P., Ho, S. T., Sun, W. Z., Wang, M. S. & Cleeland, C. S.(1998) Validation of the brief pain inventory in a Taiwan population. Journal of pain and symptom management, 18(5), 316-322.
Gloth, F. M.(2000) Geriatric pain: Factors that limit pain relief and increase complication. Geriatrics , 55(10), 46-52.
Gloth, F. M., Scheve, A. A., Chow, S., Prosser, J. M.(1999) Validity and responsiveness of the functional pain scale. Journal of American society, 47, S91.
Gordon, D. B.(1999) Pain management in the elderly. Journal of perianesthesia nursing, 14(6), 367-372.
Hallal, C. J.(1991) Back pain with postmenopausal osteoporosis and vertebral fractures. Geriatric Nursing, 24(6), 285-287.
Helme, R. d., Katz, B., Gibson, S. J. Bradbeer, M., Neufeld, M., Corran, T.(1996) Multidisciplinary pain clinics for older people: do they have a role?, Clinic geriatric medicine , 12, 563-82.
Hewitt, D.J., Foley, K. M.(1990) Management in the elderly.-principles of geriatric medicine. New York, McGraw-Hill.
Horwitz, A. D., Hosek, R., Boyle, J., Cianciulli, A., Glass, J, Codario, R.(1998) A new gatekeeper for back pain. The American journal of managed care, 4(4), 576-579.
Hubbard, P., Muhlenkamp, A. F., & Brown, N.(1984) The relationship between social support and self-care practices. Nursing research, 33, 266-270.
Jones J. S., Johnson, K., McNinch, M.(1996) Age as a risk factor for inadequate emergency department analgesia. American journal of emergency medicine. 14(2), 157-160.
Lansbury, G..(2000) Chronic pain management: a qualitative study of elderly person’s preferred coping strategies and barriers to management. Journal of disability and rehabilitation, 22 (1), 2-14.
Lazarus, R. S., & Folkman, S.(1984) Stress, appraisal, and coping. New York: Springer.
Mayo Clinic(2001) Mayo clinic on chronic pain: Lead a more active and productive life with answers from the world-renownedmayo clinic〔慢性疼痛〕（林智生譯）. 台北：天下生活。（原著出版於1999）。
McCaffery, M.(1989) Nursing management of patient with pain, St. Louis: C. V. Mosby.
Melzack, R.(1987) The short-form Mc-Gill pain questionnaire. Pain, 30, 191-197.
Melzack, R., & Wall, P. D.(1965) Pain mechanisms: A new theory. Science, 150, 971-990.
Mobily, P. R. & Herr, K. A.(1992) Back pain in the elderly. Geriatric nursing, 2, 110-116.
Monti, D. A., Kunkel, E. J. S.(1998) Management of chronic pain among elderly patients. Psychiatric services, 49(12) 1537-1539.
Moritz, U.(1979) Evaluation of manipulation and other manual therapy; Criteria for measuring the effect of treatment. Scand of journal of rehabilitation medicine, 11, 175-179.
Novy, C. M. Jagmin, M. G..(1997) Pain management in the elderly orthopaedic patient. Orthopaedic nursing16(1). 51-57.
Nwuga, VC. B.(1982) Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. American journal of physical medicine, 61(6), 273-277.
Ogon M. K., Sollner W. K., Rumplmair W. Lampe A.(1996) Chronic low back pain measurement with visual analogue scales in different settings. Pain. 64(3): 425-8, 1996 Mar.
Parmelee, P. A. Kaze, I. R. Lawton, M. P.(1991) The relation of pain to depression among institutionalized aged .Journal of gerontology ,46(1), 15-21.
Pickering, G. Jourdan, D. Eschalier, A. Dubray, C.(2002) Impact of age, gender and Cognitive functioning on pain perception. Gerontology, 48: 112-118.
Polatin, P. B., Gatchel, R. J., Barnes, D. B., Mayer, H. M., Arens, C., Mayer, T. G..(1989) A psychosociomedical prediction model of response to treatment to treatment by chronically disabled workers with low back pain. Spine, 14(9), 956-961.
Polit, D. F., & Hungler, B. P.(1999) Nursing Research - Principles and Methods. Philadephia: Lippincott.
Portenoy, R. K. & Farkash, A.(1988) Practical management of non management pain in the elderly. Geriatrics, 41, 29-47.
Richardson, J.(2001) Integrating complementary therapies into health care education: a course approach. Journal of Clinical Nursing, 10(6), 793-798.
Rosenstiel, A. K., & Keefe, F. J.(1983) The use of coping strategies in chronic low back pain patient relationship to patient characteristics and current adjustment. Pain, 17, 33-44.
Roberts, G.., Roberts, E. E., Lloyd, K. N., Evans, D.P.(1978) Lumbarspinal manipulation on trial, part II - radiological assessment. Rheumat Rehabil, 17, 54-59.
Roy, R. Thomas, M.(1986) A survey of chronic pain in an elderly population. Canadian family physician, 32: 513-516.
Santavirta, N., Bjorvell, H., Solovieva, S., Alaranta, H., Hurskainen, K., & Konttinen, Y.(2001) Coping strategies, pain, and disability in patients with hemophilia and related disorders. Arthritis care & research, 45, 48-55.
Schulz, R., Williamson, G.. M.(1992) Pain, activity restriction, and symptoms of depression among community-resident elderly adults. Journal of gerontology: psychological sciences, 47(6), 367-372.
Sims-Williams, H., Jayson, M. I., Young, S. M., Baddeley, H., and Collins, E. (1979) Controlled trial of mobilization and manipulation low back pain: Hospital patients. Brit. Med. J., 24, 1318-1320.
Smith, B. H., Elliott, A.M., Chambers, W.A. Smith, W.C., Hannaford, P.C., Penny, K.(2001) The impact of chronic pain in the community. Family practice, 18(3), 292-299.
Turner, J. A., & Clancy, S.(1986) Strategies for coping with chronic low back pain: relationship to pain and disability. Pain, 24, 335-364.
Verheek, P. F., Kerssens, J. J, Dekker, J., Sorbi, M.J., Bensing, J.M.（1998） Prevalence of chronic pain complaints. Pain, 32, 173-183.
Von Korff, M., Dworkin, S. F., Le Resche, L.(1990) Graded chronic pain status: an epidemiologic evaluation. Pain, 40(3), 279-291.
Waltz, C., Strickland, O., & Lenz, E.(1991) Measurement in nursing research(2nd ed). Philadel: Lippincott.
Wang, X. S., Mwndoza, T. R., Gao, S. Z. & Cleeland, C. S. (1993) The Chinese version of the Brief Pain Inventory its development and use in a study of cancer pain. Pain, 67, 407-416.
Wortring, R.A. (1993) Cancer pain management. Home health care nurse, 11(5), 40-44.
Weiner, D. K., Rudy, T. E., Gaur, S.(2001) Are all older adults with persistent pain created equal? Preliminary evidence for a multiaxial taxonomy. Pain research & management, 6(3), 133-141.
Woolf, C. J.(1993) The pathophysiology of peripheral neuropathic pain - abnormal peripheral input and abnormal central processing. Acta Neurochirurgica - Supplementum. 58:125-30, 1993.