Summers Jay D, Rapoff Michael A, Varghese George, Porter Kent, Palmer Richard E
Department of Psychology, University of Kansas, Lawrence, KS 66045, USA Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS 66103, U.S.A. Kansas City VA Medical Center, Kansas City, MO 64128, U.S.A.
Pain. 1991 Nov;47(2):183-189. doi: 10.1016/0304-3959(91)90203-A.
Chronic pain is a problem among patients with spinal cord injuries, but the psychosocial factors associated with spinal cord injury (SCI) pain are not well understood. To understand SCI pain further, 54 patients (19 with quadriplegia and 35 with paraplegia) completed the Beck Depression Inventory, State-Trait Anxiety Inventory, Profile of Mood States, Acceptance of Disability Scale and SCI Interference Scale. Forty-two patients stated they had SCI pain and completed the Multidimensional Pain Inventory and the Pain Experience Scale. Results revealed that anger and negative cognitions were associated with greater pain severity. Patients who reported pain in response to a general prompt experienced more severe pain than patients who reported pain only when directly questioned about the presence of pain, but these different reporting groups did not differ on emotional variables. Those who were less accepting of their disability reported greater pain severity. Additionally, patients who perceived a significant other expressing punishing responses (e.g., expressing anger at the patients or ignoring the patients) to their pain behaviors reported more severe pain. Level of lesion, completeness of injury, surgical fusion and/or instrumentation and veteran status were not associated with pain severity. Finally, pain was associated with emotional distress over and above the distress associated with the SCI itself. Overall, psychosocial factors, not physiological factors, were most closely associated with the experience of pain. Multidimensional aspects of pain are used to explain these findings and suggest that treatment should be directed at the emotional and cognitive sequelae of chronic SCI pain.
慢性疼痛是脊髓损伤患者面临的一个问题，但与脊髓损伤（SCI）疼痛相关的社会心理因素尚未得到充分理解。为了进一步了解SCI疼痛，54名患者（19名四肢瘫痪患者和35名下半身瘫痪患者）完成了贝克抑郁量表、状态-特质焦虑量表、情绪状态剖面图、残疾接受量表和SCI干扰量表。42名患者表示他们患有SCI疼痛，并完成了多维疼痛量表和疼痛体验量表。结果显示，愤怒和消极认知与更高的疼痛严重程度相关。对一般提示做出疼痛反应的患者比仅在直接被问及是否存在疼痛时才报告疼痛的患者经历更严重的疼痛，但这些不同的报告组在情绪变量上没有差异。那些对自己的残疾接受度较低的患者报告的疼痛严重程度更高。此外，那些认为重要他人对其疼痛行为表现出惩罚性反应（例如，对患者发怒或忽视患者）的患者报告的疼痛更严重。损伤水平、损伤完整性、手术融合和/或器械植入以及退伍军人身份与疼痛严重程度无关。最后，疼痛与SCI本身相关的痛苦之外的情绪困扰有关。总体而言，社会心理因素而非生理因素与疼痛体验最为密切相关。疼痛的多维度方面被用来解释这些发现，并表明治疗应针对慢性SCI疼痛的情绪和认知后遗症。
