Carleton R Nicholas, Asmundson Gordon J G
The Anxiety and Illness Behaviour Laboratory, University of Regina, Regina, Saskatchewan.
J Pain. 2009 Jan;10(1):29-37. doi: 10.1016/j.jpain.2008.06.007. Epub 2008 Aug 16.
Current fear-anxiety-avoidance models of chronic pain emphasize pain-related fear and anxiety as potential precursors for disabling chronic pain; however, anxiety and fear are often used interchangeably when discussing pain. Fear is a present-oriented emotive state associated with an imminent threat (eg, a patient about to receive an injection), whereas anxiety is a more general, future-oriented emotive state, that occurs in anticipation of threats without requiring an objective stimulus (eg, the possibility of receiving an injection). Theoretical and empirical evidence suggests pain-related fear and anxiety represent distinct cognitive constructs. Moreover, pain-related anxiety has been posited as a manifestation of anxiety sensitivity, which has implications for several theoretical models as well as treatment. The Fear of Pain Questionnaire and the Pain Anxiety Symptoms Scale-20 are popular measures, often used comparably, that were designed to measure pain-related fear and anxiety, respectively. These measures, along with the Anxiety Sensitivity Index, were administered to an undergraduate sample (N = 268; 66% women). Results of confirmatory factor analyses suggest each measure represents a related, but distinct, construct. Furthermore, correlations with anxiety sensitivity suggest that pain-related anxiety may be better conceptualized as a fundamental fear. Implications and directions for future research are discussed.
Fear-anxiety-avoidance models of chronic pain posit pain-related fear and anxiety as diatheses for disabling chronic pain. This research suggests theoretical and clinical distinctions between pain-related fear and anxiety. Moreover, pain-related anxiety appears more complex than a manifestation of anxiety sensitivity; pain-related anxiety may be better conceptualized as a fundamental fear.
当前慢性疼痛的恐惧-焦虑-回避模型强调与疼痛相关的恐惧和焦虑是导致慢性疼痛致残的潜在先兆；然而，在讨论疼痛时，焦虑和恐惧常常被互换使用。恐惧是一种与迫在眉睫的威胁相关的当下导向的情绪状态（例如，一名即将接受注射的患者），而焦虑是一种更普遍的、未来导向的情绪状态，它在预期威胁时出现，无需客观刺激（例如，可能接受注射）。理论和实证证据表明，与疼痛相关的恐惧和焦虑代表不同的认知结构。此外，与疼痛相关的焦虑被认为是焦虑敏感性的一种表现，这对几种理论模型以及治疗都有影响。《疼痛恐惧问卷》和《疼痛焦虑症状量表-20》是常用的测量工具，通常被同等使用，它们分别旨在测量与疼痛相关的恐惧和焦虑。这些测量工具，连同《焦虑敏感性指数》，被施用于一个本科样本（N = 268；66%为女性）。验证性因素分析结果表明，每个测量工具都代表一个相关但不同的结构。此外，与焦虑敏感性的相关性表明，与疼痛相关的焦虑可能更好地被概念化为一种基本恐惧。文中讨论了未来研究的意义和方向。
慢性疼痛的恐惧-焦虑-回避模型将与疼痛相关的恐惧和焦虑视为导致慢性疼痛致残的素质。这项研究表明了与疼痛相关的恐惧和焦虑在理论和临床上的区别。此外，与疼痛相关的焦虑似乎比焦虑敏感性的表现更为复杂；与疼痛相关的焦虑可能更好地被概念化为一种基本恐惧。
