Williams David A, Keefe Francis J
Department of Psychiatry, Georgetown University Medical Center, Washington, DC 2007 U.S.A. Department of Psychiatry, Duke University Medical Center, Durham, NC 27710 U.S.A.
Pain. 1991 Aug;46(2):185-190. doi: 10.1016/0304-3959(91)90074-8.
Patients' beliefs about chronic pain, such as how long it will last and whether it is a mysterious experience, have been shown to be related to compliance with treatment programs. The present study examined whether these pain beliefs related to a specific component of pain management, namely the frequency of use and the perceived effectiveness of cognitive and behavioral coping strategies. One hundred twenty chronic pain patients were administered the Pain Beliefs and Perceptions inventory (PBAPI) and the Coping Strategies questionnaire (CSQ). A cluster analysis of 2 pain beliefs (that pain is enduring and that pain is mysterious) was conducted revealing 3 distinct subgroups of patients based upon these 2 beliefs. Multivariate analysis of variance was used to detect whether the use of cognitive-behavioral pain coping strategies differed in patients in the 3 pain beliefs subgroups. The results indicated that patients belonging to the group characterized by the belief that pain was enduring and mysterious were less likely to use cognitive coping strategies (e.g., reinterpretation of pain sensation), more likely to catastrophize, and less likely to rate their coping strategies as effective in controlling and decreasing pain than patients believing their pain to be understandable and of short duration. The implications of these results for understanding the patient's choice of and compliance with treatment and coping efforts is discussed.
患者对慢性疼痛的信念，比如疼痛会持续多久以及它是否是一种神秘的体验，已被证明与治疗方案的依从性有关。本研究考察了这些疼痛信念是否与疼痛管理的一个特定组成部分相关，即认知和行为应对策略的使用频率以及感知到的有效性。对120名慢性疼痛患者进行了疼痛信念与认知量表（PBAPI）和应对策略问卷（CSQ）的测试。基于疼痛是持久的以及疼痛是神秘的这两种疼痛信念进行聚类分析，结果显示患者分为3个不同的亚组。采用多变量方差分析来检测这3个疼痛信念亚组的患者在使用认知行为疼痛应对策略方面是否存在差异。结果表明，与那些认为自己的疼痛是可以理解的且持续时间较短的患者相比，那些具有疼痛是持久的且神秘的信念特征的患者较少使用认知应对策略（如对疼痛感觉进行重新诠释），更易出现灾难化思维，并且不太可能认为自己的应对策略在控制和减轻疼痛方面有效。本文讨论了这些结果对于理解患者对治疗的选择、依从性以及应对努力的意义。
