Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Pain. 2011 Nov;152(11):2596-2604. doi: 10.1016/j.pain.2011.08.002. Epub 2011 Sep 1.
Women with metastatic breast cancer (MBC) rely on their partners for emotional and practical support. They also experience significant pain and depression, which can trigger maladaptive pain behaviors (eg, distorted ambulation). The biopsychosocial model of pain posits that partner solicitous responses can reinforce pain behaviors, whereas punishing or distracting responses can minimize their occurrence. This study explored how psychosocial variables (ie, depression and partner responses) influence patient pain behaviors and partner responses in 191 couples coping with MBC. Because few studies have examined the biopsychosocial model in cancer, it also examined associations between partner responses and patient pain behaviors. Multilevel models showed that depression partially mediated: (1) associations between patients' and partners' reports of patient pain (MPI) and their ratings of patient pain behaviors (PBCL), accounting for 41% to 71% of the variance; and (2) associations between both partners' reports of patient pain and the partner's distracting and punishing responses (MPI), accounting for 66% to 75% of the variance. Partner punishing responses moderated associations between patient pain severity and pain behaviors. Specifically, punishing responses were associated with more pain behaviors for patients with low levels of pain and fewer pain behaviors for patients with higher levels of pain (effect size r=.18). These findings provide partial support for the biopsychosocial model of pain but also clarify and extend it in the cancer context. Future pain management programs in MBC may benefit from addressing both partners' depression levels and teaching partners to engage in fewer punishing responses when the patient is experiencing low levels of pain.
患有转移性乳腺癌（MBC）的女性依赖伴侣提供情感和实际支持。她们还经历着严重的疼痛和抑郁，这可能会引发适应不良的疼痛行为（例如，姿势扭曲）。疼痛的心理社会模型假设，伴侣的关心反应可能会强化疼痛行为，而惩罚或分散注意力的反应则可能减少其发生。本研究探讨了心理社会变量（即抑郁和伴侣反应）如何影响 191 对夫妇应对 MBC 时患者的疼痛行为和伴侣的反应。由于很少有研究在癌症中检验心理社会模型，因此本研究还检验了伴侣反应与患者疼痛行为之间的关联。多层次模型表明，抑郁部分介导了：（1）患者和伴侣对患者疼痛报告（MPI）的报告与其对患者疼痛行为评分（PBCL）之间的关联，占 41%至 71%的方差；以及（2）患者报告的疼痛和伴侣的分散和惩罚反应（MPI）之间的关联，占 66%至 75%的方差。伴侣的惩罚反应调节了患者疼痛严重程度与疼痛行为之间的关联。具体而言，对于疼痛程度较低的患者，惩罚反应与更多的疼痛行为相关，而对于疼痛程度较高的患者，惩罚反应与更少的疼痛行为相关（效应大小 r =.18）。这些发现为疼痛的心理社会模型提供了部分支持，但也在癌症背景下对其进行了澄清和扩展。未来的 MBC 疼痛管理计划可能受益于解决双方的抑郁水平，并教导伴侣在患者疼痛程度较低时减少惩罚反应。
