Department of Personality, Assessment and Psychological Treatment, University of Málaga, Málaga, Spain.
Eur J Pain. 2012 May;16(5):718-26. doi: 10.1002/j.1532-2149.2011.00035.x. Epub 2011 Dec 19.
Anxiety sensitivity has been included in the fear-avoidance model as a vulnerability factor to explain individual differences in fear of pain. Several studies have suggested that the relationship between anxiety sensitivity and some psychopathological disorders is mediated by experiential avoidance, an affect-related regulatory process that involves unwillingness to endure private experiences. The role of these constructs as vulnerability variables has not been investigated in chronic pain patients. The aim of this study was to investigate the role of anxiety sensitivity and experiential avoidance as dispositional variables in pain fear-avoidance. Two alternative hypothetical models were tested: one in which anxiety sensitivity and experiential avoidance would be independently associated with pain fear-avoidance; and second, one in which experiential avoidance would mediate the relationship between anxiety sensitivity and pain fear-avoidance. The sample was composed of 299 patients with chronic back pain. The postulated relationships were tested using LISREL 8.20 software (Scientific Software International, Chicago, IL, USA) and the generally weighted least squares. The structural equation modelling analyses showed that experiential avoidance and anxiety sensitivity were independently associated with pain fear-avoidance and that anxiety sensitivity had a stronger association with pain fear-avoidance than experiential avoidance. The alternative model, in which experiential avoidance mediates the relationship between anxiety sensitivity and pain fear-avoidance, gave a much worse fit. These results highlight the importance of both anxiety sensitivity and experiential avoidance as variables which could explain individual differences in pain fear-avoidance. Thus, in terms of prevention, it should be a priority to identify patients with increased anxiety sensitivity and experiential avoidance during the first stages of the development of chronic pain conditions.
焦虑敏感已被纳入恐惧回避模型，作为解释个体对疼痛恐惧差异的易感性因素。有几项研究表明，焦虑敏感与某些精神病理障碍之间的关系是由经验回避介导的，经验回避是一种与情感相关的调节过程，涉及到不愿意忍受个人经历。这些结构作为易感性变量在慢性疼痛患者中尚未得到研究。本研究旨在探讨焦虑敏感和经验回避作为慢性疼痛患者疼痛恐惧回避的特质变量的作用。测试了两种替代的假设模型：一种是焦虑敏感和经验回避独立与疼痛恐惧回避相关；另一种是经验回避中介焦虑敏感和疼痛恐惧回避之间的关系。样本由 299 名慢性背痛患者组成。使用 LISREL 8.20 软件（Scientific Software International，芝加哥，IL，美国）和广义最小二乘法测试了假设的关系。结构方程模型分析表明，经验回避和焦虑敏感与疼痛恐惧回避独立相关，且焦虑敏感与疼痛恐惧回避的相关性强于经验回避。经验回避中介焦虑敏感和疼痛恐惧回避关系的替代模型拟合度较差。这些结果强调了焦虑敏感和经验回避作为解释疼痛恐惧回避个体差异的变量的重要性。因此，在预防方面，在慢性疼痛状况发展的早期阶段，识别出焦虑敏感和经验回避增加的患者应是当务之急。
