Haythornthwaite Jennifer A, Clark Michael R, Pappagallo Marco, Raja Srinivasa N
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 101 Meyer, 600 N. Wolfe St., Baltimore, MD 21287-7218, USA Department of Neurosciences, New York University School of Medicine, New York, NY, USA Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287-7218, USA.
Pain. 2003 Dec;106(3):453-460. doi: 10.1016/j.pain.2003.09.009.
Post-herpetic neuralgia (PHN) is a neuropathic pain state that is often difficult to treat. Although frequently discussed in the clinical literature, little is known about the impact of pain on daily function and the extent to which psychosocial factors, in particular pain coping strategies, influence adaptation to this chronic illness. In the context of a crossover pharmacological trial, 68 patients with PHN completed a battery of psychological measures during a first drug-free baseline period. Following discontinuation of approximately 8 weeks of treatment, 49 of these patients completed data collection during a second drug-free assessment prior to beginning a second drug phase. Twice-weekly telephone pain ratings were combined with questionnaire measures of perceived interference due to pain, overall activity level, depressive symptoms, and pain coping strategies. Cross-sectional hierarchical regression analyses indicated that catastrophizing correlated with depressive symptoms but not pain, and coping self-statements were correlated with higher levels of overall activity. Prospective hierarchical regression analyses indicated that catastrophizing at baseline predicted level of pain 8 weeks later, an effect that was independent of baseline pain and depressive symptoms. Patients who reported increasing their activity in response to pain also reported more perceived interference due to pain 8 weeks later. Higher levels of ignoring pain sensations at baseline were prospectively correlated with more depressive symptoms 8 weeks later. These findings support a role for the continued investigation of cognitive-behavioral factors affecting the adaptation of elderly individuals experiencing PHN.
带状疱疹后神经痛（PHN）是一种往往难以治疗的神经性疼痛状态。尽管在临床文献中经常被讨论，但对于疼痛对日常功能的影响以及心理社会因素（尤其是疼痛应对策略）在多大程度上影响对这种慢性病的适应，人们了解甚少。在一项交叉药理学试验中，68例PHN患者在第一个无药基线期完成了一系列心理测量。在大约8周的治疗中断后，其中49例患者在开始第二个药物治疗阶段之前的第二个无药评估期间完成了数据收集。每周两次的电话疼痛评分与因疼痛导致的感知干扰、总体活动水平、抑郁症状和疼痛应对策略的问卷调查相结合。横断面分层回归分析表明，灾难化思维与抑郁症状相关，但与疼痛无关，而应对自我陈述与更高水平的总体活动相关。前瞻性分层回归分析表明，基线时的灾难化思维可预测8周后的疼痛程度，这一效应独立于基线疼痛和抑郁症状。报告因疼痛而增加活动量的患者在8周后也报告了更多因疼痛导致的感知干扰。基线时更高水平的忽视疼痛感觉与8周后更多的抑郁症状呈前瞻性相关。这些发现支持继续研究影响老年PHN患者适应情况的认知行为因素。
