Kim Ho-Joong, Cho Chan-Hee, Kang Kyoung-Tak, Chang Bong-Soon, Lee Choon-Ki, Yeom Jin S
Spine Center, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea; Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea.
Department of Mechanical Engineering, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul, Republic of Korea.
Spine J. 2015 Feb 1;15(2):238-46. doi: 10.1016/j.spinee.2014.09.002. Epub 2014 Sep 18.
Pain intensity in various chronic pain disorders has been associated with catastrophizing. Considering the pathomechanism and clinical symptoms of lumbar spinal stenosis (LSS), pain catastrophizing could be associated with pain intensity and disability in patients with LSS.
Firstly, to determine whether catastrophizing is associated with an increased intensity of pain and disability, and secondly, to determine whether it is linked to the relationship of gender to pain and disability in patients with degenerative LSS by using mediation analyses with bootstrapping.
Medical records review.
Patients with degenerative LSS were included.
They included visual analog scale (VAS) for back pain, VAS for leg pain, Oswestry Disability Index (ODI), and pain catastrophizing scale (PCS).
Ninety-five patients who were diagnosed with degenerative LSS were included in this study. Detailed demographic data including age, sex, and body mass index and series of questionnaires were collected, including PCS, ODI, and VAS for back and leg pain. Radiologic analysis including the grade of canal stenosis and disc/facet joint degeneration was performed using magnetic resonance imaging and computed tomography findings. After adjustment of covariates, multivariate regression analysis was used to assess each component of the proposed mediation models among VAS for back/leg pain, ODI, gender, and PCS. Mediation was also assessed by the bootstrapping technique.
Pain catastrophizing demonstrated a significant positive association with pain intensity and disability represented by VAS for back and leg pain and ODI scores. The mediation analysis confirmed the mediating role of VAS for back pain in the relationship between PCS and ODI. Furthermore, multivariate regression analysis with bootstrapping demonstrated that the PCS significantly mediated the gender differences in VAS for back pain and ODI.
Pain catastrophizing was a mediator of gender differences for back pain and disability in patients with LSS. In addition, pain catastrophizing was associated with disability in LSS, which was partially mediated by increased back pain intensity.
多种慢性疼痛疾病的疼痛强度与灾难化思维有关。考虑到腰椎管狭窄症（LSS）的发病机制和临床症状，疼痛灾难化思维可能与LSS患者的疼痛强度和残疾程度有关。
第一，确定灾难化思维是否与疼痛强度增加和残疾程度相关；第二，通过使用自抽样法进行中介分析，确定其是否与退行性LSS患者的性别与疼痛及残疾之间的关系有关。
病历回顾。
纳入退行性LSS患者。
包括背痛视觉模拟量表（VAS）、腿痛VAS、Oswestry功能障碍指数（ODI）和疼痛灾难化量表（PCS）。
本研究纳入95例诊断为退行性LSS的患者。收集详细的人口统计学数据，包括年龄、性别和体重指数，并收集一系列问卷，包括PCS、ODI以及背痛和腿痛的VAS。使用磁共振成像和计算机断层扫描结果进行放射学分析，包括椎管狭窄程度和椎间盘/小关节退变情况。在调整协变量后，采用多元回归分析评估VAS背痛/腿痛、ODI、性别和PCS之间所提出的中介模型的各个组成部分。还通过自抽样法评估中介作用。
疼痛灾难化思维与以背痛和腿痛VAS以及ODI评分表示的疼痛强度和残疾程度呈显著正相关。中介分析证实了背痛VAS在PCS与ODI关系中的中介作用。此外，自抽样法多元回归分析表明，PCS显著介导了背痛VAS和ODI中的性别差异。
疼痛灾难化思维是LSS患者背痛和残疾性别差异的中介因素。此外，疼痛灾难化思维与LSS患者的残疾有关，部分原因是背痛强度增加起到了中介作用。
