Cook Andrew J, Brawer Peter A, Vowles Kevin E
Department of Anesthesiology, Division of Pain Management, University of Virginia Health System, Charlottesville, VA 22908, USA The Miriam Hospital, Brown Medical School, Providence, RI, USA.
Pain. 2006 Apr;121(3):195-206. doi: 10.1016/j.pain.2005.11.018. Epub 2006 Feb 21.
The cognitive-behavioral, fear-avoidance (FA) model of chronic pain (Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363-72) has found broad empirical support, but its multivariate, predictive relationships have not been uniformly validated. Applicability of the model across age groups of chronic pain patients has also not been tested. Goals of this study were to validate the predictive relationships of the multivariate FA model using structural equation modeling and to evaluate the factor structure of the Tampa Scale of Kinesiophobia (TSK), levels of pain-related fear, and fit of the FA model across three age groups: young (< or =40), middle-aged (41-54), and older (> or =55) adults. A heterogeneous sample of 469 chronic pain patients provided ratings of catastrophizing, pain-related fear, depression, perceived disability, and pain severity. Using a confirmatory approach, a 2-factor, 13-item structure of the TSK provided the best fit and was invariant across age groups. Older participants were found to have lower TSK fear scores than middle-aged participants for both factors (FA, Harm). A modified version of the Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H (Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363-72.) FA model provided a close fit to the data (chi(2)(29)=42.0, p>0.05, GFI=0.98, AGFI=0.97, CFI=0.99, RMSEA=0.031 (90% CI 0.000-0.050), p close fit=0.95). Multigroup analyses revealed significant differences in structural weights for older vs. middle-aged participants. For older chronic pain patients, a stronger mediating role for pain-related fear was supported. Results are consistent with a FA model of chronic pain, while indicating some important age group differences in this model and in levels of pain-related fear. Longitudinal testing of the multivariate model is recommended.
慢性疼痛的认知行为、恐惧回避（FA）模型（Vlaeyen JWS，Kole-Snijders AMJ，Boeren RGB，van Eek H。慢性下腰痛中对运动/（再）损伤的恐惧及其与行为表现的关系。疼痛1995a；62：363 - 72）已获得广泛的实证支持，但其多变量预测关系尚未得到一致验证。该模型在慢性疼痛患者各年龄组中的适用性也未得到检验。本研究的目的是使用结构方程模型验证多变量FA模型的预测关系，并评估坦帕运动恐惧量表（TSK）的因子结构、疼痛相关恐惧水平以及FA模型在三个年龄组：年轻（≤40岁）、中年（41 - 54岁）和老年（≥55岁）成年人中的拟合度。469名慢性疼痛患者的异质性样本提供了关于灾难化、疼痛相关恐惧、抑郁、感知残疾和疼痛严重程度的评分。采用验证性方法，TSK的一个双因子、13项结构提供了最佳拟合，且在各年龄组中具有不变性。发现老年参与者在两个因子（FA，伤害）上的TSK恐惧得分均低于中年参与者。Vlaeyen JWS、Kole-Snijders AMJ、Boeren RGB、van Eek H（慢性下腰痛中对运动/（再）损伤的恐惧及其与行为表现的关系。疼痛1995a；62：363 - 72。）的FA模型的一个修改版本与数据拟合良好（卡方（29）=42.0，p>0.05，GFI = 0.98，AGFI = 0.97，CFI = 0.99，RMSEA = 0.031（90%CI 0.000 - 0.050），p接近拟合 = 0.95）。多组分析显示老年与中年参与者在结构权重上存在显著差异。对于老年慢性疼痛患者，疼痛相关恐惧的中介作用更强得到了支持。结果与慢性疼痛的FA模型一致，同时表明该模型以及疼痛相关恐惧水平在一些重要的年龄组差异。建议对多变量模型进行纵向测试。
