Archer Kristin R, Abraham Christine M, Song Yanna, Obremskey William T
Division of Trauma, Department of Orthopaedics & Rehabilitation, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA.
J Trauma Acute Care Surg. 2012 Feb;72(2):473-9. doi: 10.1097/TA.0b013e3182245ece.
Approximately, 2.5 million trauma survivors are hospitalized each year, with the majority experiencing prolonged and profound pain-related disability. The present study investigated the association between fear of movement and pain catastrophizing and pain and physical health 2 years after high-energy trauma.
One hundred eight adult patients admitted to a Level I trauma intensive care unit, between July 2006 and July 2007, were contacted by phone 2 years after multiple trauma. Eighty-four (78%) participants completed measures of fear of movement, pain catastrophizing, pain intensity and interference with activity, and physical health. Patient and injury characteristics were abstracted from the medical record and a research database. Hierarchical multivariable linear regression analyses examined the unique contribution of fear of movement and pain catastrophizing to pain and physical health outcomes.
Fear of movement and catastrophizing explained a significant proportion of variance in pain intensity (29%), pain interference (34%), and physical health (19%), after controlling for age, sex, intensive care unit stay, and depression. Fear of movement and pain catastrophizing were independently associated with pain intensity and physical health, but only pain catastrophizing was associated with pain interference (p < 0.05).
Results suggest that fear of movement and catastrophizing are risk factors for poor long-term outcomes after traumatic injury. Prospective studies are warranted to test the fear-avoidance model and determine whether the model may be relevant for explaining the development of chronic pain and disability in trauma survivors. The identification of subgroups based on negative pain beliefs may have the potential to improve outcomes after traumatic injury.
每年约有250万创伤幸存者住院，其中大多数人经历了长期且严重的疼痛相关残疾。本研究调查了高能创伤两年后运动恐惧、疼痛灾难化思维与疼痛及身体健康之间的关联。
2006年7月至2007年7月期间入住一级创伤重症监护病房的108名成年患者在多发伤两年后通过电话进行随访。84名（78%）参与者完成了运动恐惧、疼痛灾难化思维、疼痛强度及对活动的干扰以及身体健康状况的测量。从病历和研究数据库中提取患者及损伤特征。分层多变量线性回归分析检验了运动恐惧和疼痛灾难化思维对疼痛及身体健康结局的独特贡献。
在控制了年龄、性别、重症监护病房住院时间及抑郁因素后，运动恐惧和灾难化思维解释了疼痛强度（29%）、疼痛干扰（34%）和身体健康（19%）中很大比例的变异。运动恐惧和疼痛灾难化思维与疼痛强度和身体健康独立相关，但只有疼痛灾难化思维与疼痛干扰相关（p < 0.05）。
结果表明，运动恐惧和灾难化思维是创伤性损伤后长期预后不良的危险因素。有必要进行前瞻性研究以检验恐惧回避模型，并确定该模型是否可能与解释创伤幸存者慢性疼痛和残疾的发展相关。基于消极疼痛信念识别亚组可能有改善创伤性损伤后结局的潜力。
