Health Psychology Section, Institute of Psychiatry, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, UK.
J Psychosom Res. 2015 Jan;78(1):12-24. doi: 10.1016/j.jpsychores.2014.07.008. Epub 2014 Jul 15.
Pain is a common symptom of Multiple Sclerosis (MS). Biomedical treatments achieve only modest reductions in pain severity suggesting that this approach may be too narrow. The aim of this systematic review was to assess evidence for associations between modifiable psychosocial factors and MS pain severity and pain interference and use this evidence to develop a preliminary biopsychosocial model of MS pain.
Empirical studies of pain in MS utilising standardised pain severity and pain interference measures were included. Online databases (Cochrane, PsychInfo, EMBASE, CINAHL, Medline, Web of Science and World Cat) and reference sections of included articles were searched, and corresponding authors contacted to identify unpublished studies. Information about design, sample size, MS type, time since diagnosis, psychosocial and pain measures and key findings were extracted. Thirty-one studies were assessed for quality and a narrative synthesis was conducted.
Similar to primary chronic pain, most studies reported small to medium associations between several psychosocial factors and pain severity and interference. Pain catastrophizing showed consistently strong associations with pain interference. Preliminary findings revealed a strong correlation between pain acceptance and pain interference. However, fear-avoidance appeared less important in MS, and other forms of behavioural avoidance were not explored.
A preliminary model of MS pain outlining specific psychosocial factors is presented with a conceptual formulation from both traditional, and contextual, cognitive-behavioural perspectives. Pain catastrophizing, acceptance, and endurance, as opposed to fear avoidance, responses are highlighted as potentially important treatment targets in MS, and directions for future research are outlined.
疼痛是多发性硬化症（MS）的常见症状。生物医学治疗仅能适度减轻疼痛严重程度，这表明这种方法可能过于局限。本系统评价的目的是评估可改变的心理社会因素与 MS 疼痛严重程度和疼痛干扰之间的关联证据，并利用这些证据来建立 MS 疼痛的初步生物心理社会模型。
纳入了利用标准化疼痛严重程度和疼痛干扰测量的 MS 疼痛的实证研究。在线数据库（Cochrane、PsychInfo、EMBASE、CINAHL、Medline、Web of Science 和 WorldCat）和纳入文章的参考文献部分进行了检索，并联系了相应的作者以确定未发表的研究。提取了设计、样本量、MS 类型、诊断后时间、心理社会和疼痛测量以及主要发现的信息。对 31 项研究进行了质量评估，并进行了叙述性综合分析。
与原发性慢性疼痛类似，大多数研究报告了几种心理社会因素与疼痛严重程度和干扰之间的小到中等关联。疼痛灾难化与疼痛干扰始终存在强烈关联。初步发现显示疼痛接受与疼痛干扰之间存在很强的相关性。然而，在 MS 中，回避恐惧似乎不那么重要，并且没有探讨其他形式的行为回避。
提出了一个 MS 疼痛的初步模型，概述了特定的心理社会因素，并从传统和情境认知行为观点提出了概念化表述。强调疼痛灾难化、接受和耐力，而不是回避恐惧，作为 MS 中潜在的重要治疗目标，并概述了未来研究的方向。
