恐惧性疼痛在头痛中的作用。

The role of fear of pain in headache.

机构信息

Department of Psychology, University of Mississippi, Oxford, MS, USA.

出版信息

Headache. 2015 May;55(5):669-79. doi: 10.1111/head.12561. Epub 2015 Apr 22.

DOI:10.1111/head.12561

PMID:25903510

Abstract

BACKGROUND

Recurrent headache sufferers are often fearful of pain, which disrupts thought processes, interferes with daily activities, and may maintain headache-related disability through avoidance and associated negative reinforcement.

OBJECTIVE

The aim of this cross-sectional study was to (1) examine differences in fear of pain (FOP) between headache sufferers and non-headache controls; (2) examine differences in FOP across primary headache diagnostic groups; (3) assess the extent to which FOP predicts headache variables (eg., severity, frequency, disability); and (4) determine whether FOP mediates the relationship between pain severity and headache-related disability.

METHODS

The sample consisted of 908 young adults (M age = 19.5 years; 64.9% female). Of those, 237 (26.1%) met the diagnostic criteria for episodic tension-type headache (TTH), 232 (25.6%) for episodic migraine (167 [18.4%] without aura and 65 [7.2%] with aura), 38 (4.2%) for chronic migraine, and 19 (2.1%) for chronic TTH; 382 (42.1%) served as non-headache controls.

RESULTS

FOP differed among groups, with headache sufferers reporting greater FOP than those without headache; migraineurs typically endorsed greater FOP than those with TTH. Among those with headache, FOP significantly predicted headache severity (R(2) = 6.1%) and frequency (R(2) = 4.5%), and accounted for more variance in disability (R(2) = 17.5%) than gender, anxiety, and depression combined (13.8%). Pain severity and disability were strongly associated (r = 0.61, P < .001), and FOP partially mediated this association (indirect effect point estimate = 0.38; 95% confidence interval: 0.23-0.57).

CONCLUSIONS

FOP differentiates migraineurs from those without headache and plays a significant role in primary headache, particularly in headache-related disability. Findings build upon and extend those from previous chronic pain studies and highlight the need for longitudinal and experimental studies to further explore this construct in headache.

摘要

背景

反复发作头痛的患者常常对疼痛感到恐惧，这会干扰思维过程，妨碍日常活动，并可能通过回避和相关的负强化来维持与头痛相关的残疾。

目的

本横断面研究旨在：（1）比较头痛患者和非头痛对照组之间的疼痛恐惧差异；（2）比较原发性头痛诊断组之间的疼痛恐惧差异；（3）评估疼痛恐惧对头痛变量（如严重程度、频率、残疾）的预测程度；（4）确定疼痛恐惧是否在疼痛严重程度与头痛相关残疾之间起中介作用。

方法

样本包括 908 名年轻成年人（平均年龄为 19.5 岁；64.9%为女性）。其中，237 人（26.1%）符合发作性紧张型头痛（TTH）的诊断标准，232 人（25.6%）符合发作性偏头痛（167[18.4%]无先兆和 65[7.2%]有先兆），38 人（4.2%）符合慢性偏头痛，19 人（2.1%）符合慢性 TTH；382 人（42.1%）为非头痛对照组。

结果

不同组之间的疼痛恐惧存在差异，头痛患者的疼痛恐惧程度高于无头痛患者；偏头痛患者的疼痛恐惧程度通常高于 TTH 患者。在头痛患者中，疼痛恐惧显著预测头痛严重程度（R²=6.1%）和频率（R²=4.5%），并比性别、焦虑和抑郁的总和（13.8%）更好地解释残疾（R²=17.5%）。疼痛严重程度和残疾高度相关（r=0.61，P<0.001），疼痛恐惧在两者之间起部分中介作用（间接效应点估计值=0.38；95%置信区间：0.23-0.57）。