疼痛创伤敏感：主要手术患者中与疼痛相关的焦虑、疼痛灾难化和焦虑敏感的高阶因子。
Sensitivity to pain traumatization: a higher-order factor underlying pain-related anxiety, pain catastrophizing and anxiety sensitivity among patients scheduled for major surgery.
机构信息
Department of Psychology, York University, Toronto, Ontario, Canada.
出版信息
Pain Res Manag. 2011 May-Jun;16(3):169-77. doi: 10.1155/2011/932590.
BACKGROUND
The present article addresses two related developments in the psychology of pain, and integrates them into a coherent framework to better understand the relationship between pain and trauma. The first is an emerging conceptualization regarding the nature of the hierarchical organization of major pain-related anxiety constructs. The second is the theoretical rationale and empirical evidence linking pain and symptoms of post-traumatic stress disorder.
OBJECTIVES
To explore the underlying hierarchical factor structure of commonly used pain-related anxiety measures including the Pain Anxiety Symptoms Scale (PASS-20), the Pain Catastrophizing Scale (PCS), and the Anxiety Sensitivity Index (ASI); and to relate this structure to post-traumatic stress disorder in patients scheduled for major surgery.
METHODS
Measures were completed by 444 patients scheduled to undergo major surgery. Exploratory factor analysis and subsequent higherorder analysis using the Schmid-Leiman transformation were conducted to investigate the underlying factor structure of the ASI, the PCS and the PASS-20.
RESULTS
Twenty items from the ASI, the PASS-20 and the PCS loaded exclusively on one higher-order factor. The authors suggest the term 'sensitivity to pain traumatization' (SPT) for the underlying construct based in part on the strong, significant positive correlation between SPT scores and scores on the Post-traumatic Stress Disorder Checklist - Civilian Version. Finally, the total SPT score was significantly higher for patients with a history of pain than for those without a history of pain, both before surgery and one year after surgery. SPT describes the propensity to develop anxiety-related somatic, cognitive, emotional and behavioural responses to pain that resemble features of a traumatic stress reaction. Together, the results of the present study provide preliminary evidence for the construct validity of SPT.
背景
本文探讨了疼痛心理学中的两个相关发展，并将它们整合到一个连贯的框架中，以更好地理解疼痛与创伤之间的关系。第一个是关于主要与疼痛相关的焦虑结构的层次组织性质的新兴概念化。第二个是将疼痛与创伤后应激障碍症状联系起来的理论原理和实证证据。
目的
探索常用的与疼痛相关的焦虑测量方法（包括疼痛焦虑症状量表（PASS-20）、疼痛灾难化量表（PCS）和焦虑敏感性指数（ASI））的潜在层次结构；并将这种结构与计划接受重大手术的患者的创伤后应激障碍联系起来。
方法
444 名计划接受重大手术的患者完成了这些测量。使用 Schmid-Leiman 转换进行探索性因素分析和随后的高阶分析，以调查 ASI、PCS 和 PASS-20 的潜在因素结构。
结果
来自 ASI、PASS-20 和 PCS 的 20 个项目仅加载到一个高阶因素上。作者建议基于 SPT 分数与创伤后应激障碍清单-平民版（Post-traumatic Stress Disorder Checklist - Civilian Version）分数之间的强显著正相关，将潜在结构称为“对疼痛创伤化的敏感性”（Sensitivity to pain traumatization，SPT）。最后，有疼痛史的患者的总 SPT 评分明显高于无疼痛史的患者，无论是在手术前还是手术后一年。SPT 描述了对疼痛产生焦虑相关的躯体、认知、情绪和行为反应的倾向，这些反应类似于创伤后应激反应的特征。总之，本研究的结果为 SPT 的结构效度提供了初步证据。
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