Vranceanu Ana-Maria, Safren Steve, Cowan James, Ring David
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Pain Pract. 2008 Sep-Oct;8(5):337-41. doi: 10.1111/j.1533-2500.2008.00213.x. Epub 2008 May 23.
Cognitive processes play a pivotal role in the perception of pain intensity, pain-related disability, and response to medical treatments including surgeries. While various measures of dysfunctional pain coping exist in the literature, there is no instrument available to examine such negative cognitions in relation to perceptions of medical treatment in pain patients presenting to a surgical orthopedics practice.
The purpose of this article is to report on the development and preliminary testing of the Negative Pain Thoughts Questionnaire (NPTQ).
The NPTQ is an 11-item questionnaire assessing cognitions about pain and its treatment in patients presenting to orthopedics surgical practices. It was administered to 2 samples of patients with hand and arm pain seeking medical treatment in a hospital surgical practice. Patients in the second sample also completed a measure of depression and one of disability of hand, arm, and shoulder.
The NPTQ was found to be internally consistent, and unidimensional. The NPTQ total score was found to have a moderate to high positive correlation with perceived hand, arm, and shoulder disability, and a moderate positive correlation with depression. In multivariate analyses, high scores on the NPTQ significantly predicted high perceived hand, arm, and shoulder disability, even after controlling for depression.
This short and easily administered measure of negative pain thoughts could potentially help surgeons identify at risk patients, and facilitate referrals to cognitive behavioral therapy. This, in turn, may prevent unnecessary surgeries, may decrease healthcare costs, and prevent transition toward costly chronic pain syndrome.
认知过程在疼痛强度感知、疼痛相关功能障碍以及对包括手术在内的医学治疗的反应中起着关键作用。虽然文献中存在各种功能失调性疼痛应对的测量方法,但对于在接受外科骨科治疗的疼痛患者中,却没有一种工具可用于检查与对医学治疗的认知相关的此类消极认知。
本文旨在报告消极疼痛思维问卷(NPTQ)的开发及初步测试情况。
NPTQ是一份包含11个条目的问卷,用于评估在骨科手术科室就诊的患者对疼痛及其治疗的认知。该问卷被施用于在一家医院外科科室寻求治疗的两组手部和手臂疼痛患者样本。第二组样本中的患者还完成了一项抑郁测量以及一项手部、手臂和肩部功能障碍测量。
发现NPTQ具有内部一致性且为单维度。NPTQ总分与感知到的手部、手臂和肩部功能障碍呈中度至高度正相关,与抑郁呈中度正相关。在多变量分析中,即使在控制了抑郁因素后,NPTQ的高分仍能显著预测较高的手部、手臂和肩部功能障碍感知。
这种简短且易于实施的消极疼痛思维测量方法可能有助于外科医生识别有风险的患者,并促进转介至认知行为疗法。反过来,这可能预防不必要的手术,降低医疗成本,并防止向代价高昂的慢性疼痛综合征转变。