Vlaeyen Johan W S, Timmermans Carl, Rodriguez Luz-Maria, Crombez Geert, van Horne Wendy, Ayers Gregory M, Albert Adelin, Wellens Hein J J
Department of Cardiology, Hospital Maastricht, PO Box 5800, Maastricht, The Netherlands.
J Psychosom Res. 2004 Jan;56(1):139-44. doi: 10.1016/S0022-3999(03)00081-3.
This study investigated whether pain catastrophizing is associated with distress and perceived disability in patients with atrial fibrillation, whether pain catastrophizing predicts pain and fear during a medical procedure of atrial cardioversion, and whether pain catastrophizing influences the effects of an opioid analgesic during internal cardioversion.
A secondary analysis is performed upon data from a double-blind placebo-controlled trial during which the effect of intranasal butorphanol tartrate (INB) was evaluated in patients with atrial fibrillation using a step-up internal atrial cardioversion protocol. Before the procedure, patients completed measures of pain catastrophizing, mood, distress and perceived disability. After each shock, patients completed measures of pain and fear.
We found that pain catastrophizing predicted the affective pain rating of the first shock, and the fear increase during subsequent shocks. There was no effect of INB. However, when controlling for the differences in pain catastrophizing, INB significantly reduced fear as compared to placebo. This suggests that the effects of INB during atrial cardioversion were overshadowed by the effects of pain catastrophizing.
It is recommended that in future atrial cardioversion trials, stratification based on pain catastrophizing be performed. Reducing catastrophizing thinking about pain through cognitive-behavioral techniques are likely to reduce levels of fear during internal atrial cardioversion and may increase the effectiveness of concomitant analgesics.
本研究调查了疼痛灾难化是否与房颤患者的痛苦和感知到的残疾相关，疼痛灾难化是否能预测心房复律医疗程序中的疼痛和恐惧，以及疼痛灾难化是否会影响内部复律过程中阿片类镇痛药的效果。
对一项双盲安慰剂对照试验的数据进行二次分析，该试验使用逐步内部心房复律方案评估了鼻内注射酒石酸布托啡诺（INB）对房颤患者的疗效。在手术前，患者完成了疼痛灾难化、情绪、痛苦和感知到的残疾的测量。每次电击后，患者完成疼痛和恐惧的测量。
我们发现疼痛灾难化可预测首次电击时的情感性疼痛评分以及随后电击期间恐惧的增加。INB没有效果。然而当控制疼痛灾难化的差异时，与安慰剂相比，INB显著降低了恐惧。这表明在心房复律过程中，INB的效果被疼痛灾难化的效果所掩盖。
建议在未来的心房复律试验中，根据疼痛灾难化进行分层。通过认知行为技术减少对疼痛的灾难化思维可能会降低内部心房复律期间的恐惧水平，并可能提高同时使用的镇痛药的效果。
