Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610-0154, USA.
Phys Ther. 2011 Oct;91(10):1542-50. doi: 10.2522/ptj.20100368. Epub 2011 Aug 11.
Chronic pelvic pain in women is a debilitating, costly condition often treated by physical therapists. The etiology of this condition is multifactorial and poorly understood, given the complex interplay of muscles, bones, and soft tissue that comprise the pelvis. There are few guidelines directing treatment interventions for this condition. In the last decade, several investigators have highlighted the role of psychological variables in conditions such as vulvodynia and painful bladder syndrome. Pain-related fear is the focus of the fear-avoidance model (FAM) of pain, which theorizes that some people are more likely to develop and maintain pain after an injury because of their emotional and behavioral responses to pain. The FAM groups people into 2 classes on the basis of how they respond to pain: people who have low fear, confront pain, and recover from injury and people who catastrophize pain-a response that leads to avoidance/escape behaviors, disuse, and disability. Given the presence of pain-related cognitions in women with chronic pelvic pain, including hypervigilance, catastrophizing, and anxiety, research directed toward the application of the FAM to guide therapeutic interventions is warranted. Isolated segments of the FAM have been studied to theorize why traditional approaches (ie, medications and surgery) may not lead to successful outcomes. However, the explicit application of the FAM to guide physical therapy interventions for women with chronic pelvic pain is not routine. Integrating the FAM might direct physical therapists' clinical decision making on the basis of the pain-related cognitions and behaviors of patients. The aims of this article are to provide information about the FAM of musculoskeletal pain and to provide evidence for the relevance of the FAM to chronic pelvic pain in women.
女性慢性盆腔痛是一种使人虚弱、代价高昂的疾病，通常由物理治疗师进行治疗。鉴于骨盆由肌肉、骨骼和软组织组成，其相互作用复杂，这种疾病的病因具有多因素性且尚未被充分理解。针对这种疾病，几乎没有指导治疗干预的准则。在过去的十年中，一些研究人员强调了心理变量在阴痛和膀胱疼痛综合征等疾病中的作用。疼痛相关恐惧是疼痛回避模型（FAM）的焦点，该模型理论认为，有些人在受伤后更容易出现并维持疼痛，因为他们对疼痛的情绪和行为反应。FAM 根据人们对疼痛的反应将人群分为 2 类：一类人对疼痛的恐惧程度低，直面疼痛，并从损伤中恢复；另一类人对疼痛产生灾难化反应，即回避/逃避行为、废用和残疾。鉴于患有慢性盆腔痛的女性存在与疼痛相关的认知，包括过度警觉、灾难化和焦虑，有必要针对 FAM 的应用进行研究，以指导治疗干预。已经研究了 FAM 的孤立部分，以推断为什么传统方法（即药物和手术）可能不会导致成功的结果。然而，FAM 对指导慢性盆腔痛女性的物理治疗干预的明确应用并不常见。整合 FAM 可能会根据患者的疼痛相关认知和行为来指导物理治疗师的临床决策。本文的目的是提供有关肌肉骨骼疼痛 FAM 的信息，并为 FAM 与女性慢性盆腔痛的相关性提供证据。
