Interdisciplinary Musculoskeletal Pain Assessment and Community Treatment Service, Haywood Hospital, Stoke-on-Trent PCT & Primary Care Sciences Research Centre, Keele University, Stoke-on-Trent, UK Department of Psychology, Georgia State University, Atlanta, GA, USA Centre for Pain Research, School for Health, University of Bath & Centre for Pain Services, Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK.
Pain. 2010 Dec;151(3):680-686. doi: 10.1016/j.pain.2010.08.031. Epub 2010 Sep 15.
The social context surrounding chronic pain is important, particularly in the case of pain in adolescents, where caregivers can be a key influence on adolescent social and physical activities. In general, greater adolescent difficulties are related to greater caregiver difficulties, and vice versa, although the strength of these relations has not been consistent across studies. Further, existing analyses have not evaluated more complex multivariate models involving both direct and indirect relations among adolescents and caregivers. There is consequently a lack of clarity in this area. The present analyses represent an initial attempt at explicating more precisely how adolescent and caregiver behaviors in response to pain influence adolescent functioning. Initially, a hypothetical model was constructed that included caregiver pain management behaviors, as well as adolescent and caregiver psychosocial responses to pain. The adequacy of this model was first evaluated with Pearson correlations and then with structural equation modelling using data from 120 adolescent-caregiver dyads. After some modification of the model to allow for adequate fit with the data, findings indicated that caregiver variables were only indirectly related to adolescent functioning via adolescent psychosocial responses to pain. This indirect relation may explain previous inconsistency across studies. Perhaps more importantly, the model tested may allow for an improved understanding of the complex relations among adolescents and caregivers factors. Finally, the need to adequately understand caregiver experiences in response to adolescent pain is highlighted and calls for appropriate intervention in young people struggling with chronic pain are reinforced within these analyses.
慢性疼痛的社会背景很重要，特别是在青少年疼痛的情况下，照顾者可以对青少年的社会和身体活动产生重要影响。一般来说，青少年的困难越大，照顾者的困难就越大，反之亦然，尽管这些关系的强度在不同的研究中并不一致。此外，现有的分析并没有评估更复杂的多变量模型，这些模型涉及青少年和照顾者之间的直接和间接关系。因此，这方面还存在一些不明确的地方。目前的分析代表了最初尝试更准确地阐明青少年和照顾者对疼痛的反应行为如何影响青少年的功能。最初，构建了一个假设模型，该模型包括照顾者的疼痛管理行为，以及青少年和照顾者对疼痛的心理社会反应。首先使用皮尔逊相关系数评估该模型的充分性，然后使用来自 120 个青少年-照顾者对的数据使用结构方程建模进行评估。在对模型进行一些修改以适应数据的充分性之后，研究结果表明，照顾者变量仅通过青少年对疼痛的心理社会反应间接地与青少年的功能相关。这种间接关系可能解释了之前研究中的不一致性。也许更重要的是，测试的模型可能允许更好地理解青少年和照顾者因素之间复杂的关系。最后，突出强调了充分了解照顾者对青少年疼痛的反应的必要性，并在这些分析中加强了为患有慢性疼痛的年轻人提供适当干预的必要性。
