Hassett A L, Cone J D, Patella S J, Sigal L H
Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903, USA.
Arthritis Rheum. 2000 Nov;43(11):2493-500. doi: 10.1002/1529-0131(200011)43:11<2493::AID-ANR17>3.0.CO;2-W.
Although 2 recent studies have found associations between catastrophizing and poor medical outcomes in patients with fibromyalgia syndrome (FMS), neither assessed these findings in comparison with a similar group of patients with chronic pain. Our study examined the complex relationships between depression, catastrophizing, and the multidimensional aspects of pain in women with FMS and compared these relationships with those in women with rheumatoid arthritis (RA).
Sixty-four FMS patients and 30 RA patients completed the Coping Strategies Questionnaire (CSQ), the Beck Depression Inventory II (BDI-II), and the McGill Pain Questionnaire.
Compared with subjects with RA, FMS subjects scored significantly higher on the catastrophizing subscale of the CSQ. FMS patients also earned higher scores on overall depression and on the cognitive subscale of the BDI-II. Furthermore, the relationship between catastrophizing and depression was significant in the FMS group only. Regression analyses revealed that in FMS, catastrophizing as a measure of coping predicted patients' perception of pain better than demographic variables such as age, duration of illness, and education.
Cognitive factors, such as catastrophizing and depressive self-statements, have a more pronounced role in the self-reported pain of patients with FMS than in patients with RA. Clinically, this indicates that treating pain and depression in FMS by adding cognitive therapy and coping skills components to a comprehensive treatment program may improve the outcomes obtained with pharmacologic interventions.
尽管最近两项研究发现灾难化思维与纤维肌痛综合征（FMS）患者的不良医疗结局之间存在关联，但均未将这些发现与一组类似的慢性疼痛患者进行比较评估。我们的研究探讨了FMS女性患者中抑郁、灾难化思维与疼痛多维度方面之间的复杂关系，并将这些关系与类风湿关节炎（RA）女性患者的情况进行比较。
64名FMS患者和30名RA患者完成了应对策略问卷（CSQ）、贝克抑郁量表第二版（BDI-II）和麦吉尔疼痛问卷。
与RA患者相比，FMS患者在CSQ的灾难化思维分量表上得分显著更高。FMS患者在总体抑郁和BDI-II的认知分量表上得分也更高。此外，灾难化思维与抑郁之间的关系仅在FMS组中显著。回归分析显示，在FMS患者中，作为一种应对方式的灾难化思维比年龄、病程和教育程度等人口统计学变量更能预测患者对疼痛的感知。
灾难化思维和抑郁性自我陈述等认知因素在FMS患者自我报告的疼痛中所起的作用比在RA患者中更为显著。临床上，这表明在综合治疗方案中增加认知疗法和应对技能成分来治疗FMS患者的疼痛和抑郁，可能会改善药物干预所取得的效果。
