Cedraschi Christine, Girard Elodie, Piguet Valérie, Desmeules Jules, Allaz Anne-Françoise
Division of General Medical Rehabilitation, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Health Expect. 2015 Dec;18(6):3325-35. doi: 10.1111/hex.12323. Epub 2014 Dec 10.
Fibromyalgia is characterized by chronic widespread pain and various associated symptoms, including psychological distress. This study presents a secondary analysis of the interviews of patients with fibromyalgia to appraise the affective load of the patient narratives as assessed by independent clinicians.
Three clinicians, an internist, a psychiatrist and a psychologist, who were experienced in chronic pain reviewed the interview transcripts of 56 women eliciting their views regarding fibromyalgia onset. A Clinical Global Impression (CGI) scale was used (0 = no affective load to 5 = maximum affective load) to provide a subjective appraisal of the intensity of the affective impact, as suggested in the transcripts and from the clinician perspectives.
The mean affective load was 3.6 (SD = ±1), indicating the perception of a high affective load in the clinicians. Values indicating a high or very high affective load (≥4 points on the CGI scale) were more frequent than those in the lower range [23 narratives (41%) vs. 3 (5%)]. The inter-rater agreement of the affective load of the narratives was high (K > 0.85). These results of the clinician perspectives parallel those of the patient narratives, emphasizing disruptive circumstances, psychological distress and hopelessness surrounding symptom onset.
The affective load in the narratives of these patients with fibromyalgia was high and had a negative undertone when considered from the clinicians' perspective. This study highlights the importance of considering the affective resonance in the context of therapeutic relationships that are often emotionally laden and highly challenging for the clinician.
纤维肌痛的特征为慢性广泛性疼痛及包括心理困扰在内的各种相关症状。本研究对纤维肌痛患者的访谈进行二次分析，以评估独立临床医生所评定的患者叙述中的情感负荷。
三位临床医生，一位内科医生、一位精神科医生和一位心理学家，他们在慢性疼痛方面经验丰富，回顾了56名女性关于纤维肌痛发病的访谈记录，以引出他们的观点。采用临床总体印象（CGI）量表（0 = 无情感负荷至5 = 最大情感负荷），根据记录内容并从临床医生的角度对情感影响强度进行主观评估。
平均情感负荷为3.6（标准差 = ±1），表明临床医生认为情感负荷较高。表明高或非常高情感负荷（CGI量表上≥4分）的值比低范围的值更频繁[23份叙述（41%）对3份（5%）]。叙述的情感负荷的评分者间一致性较高（K > 0.85）。临床医生观点的这些结果与患者叙述的结果相似，强调了症状发作周围的干扰性情况、心理困扰和绝望感。
从临床医生的角度来看，这些纤维肌痛患者叙述中的情感负荷较高且带有负面基调。本研究强调了在治疗关系背景下考虑情感共鸣的重要性，治疗关系通常充满情感且对临床医生极具挑战性。
