Geelen Charlotte C, Kindermans Hanne P, van den Bergh Joop P, Verbunt Jeanine A
Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.
Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.
Pain Pract. 2017 Mar;17(3):320-328. doi: 10.1111/papr.12449. Epub 2016 Mar 23.
To fully understand the burden of painful diabetic neuropathy (PDN), we investigated the relationship of pain catastrophizing with disability and quality of life in patients with PDN. Furthermore, we studied the mediating roles of physical activity and/or decline in physical activity.
This questionnaire-based cross-sectional study included 154 patients with PDN. Linear regression analyses, adjusted for age, gender, pain intensity, and insulin treatment, were performed to assess the association of pain catastrophizing (Pain Catastrophizing Scale [PCS]) with the outcome variables disability (Pain Disability Index [PDI]) and quality of life (Norfolk Quality of Life Questionnaire Diabetic Neuropathy Version [QOL-DN]). The mediating roles of actual physical activity (Physical Activity Rating Scale [PARS]) and perceived Physical Activity Decline (PAD) were assessed using mediation analyses according to Baron and Kenny.
This study included 154 patients (62% male). Mean age was 65.7 years (SD = 6.6). PCS (M = 20.3, SD = 13.1) was significantly associated with PDI (M = 32.4, SD = 17.0; R = 0.356, P < 0.001), QOL-DN (M = 52.6, SD = 26.1; R = 0.437, P < 0.001), and PAD (M = 7.4, SD = 5.7; R = 0.087, P = 0.045). PAD acted as a partial mediator in the associations of PCS with PDI and QOL-DN, respectively. There was no association of PCS with PARS.
Pain catastrophizing was associated with increased disability and decreased quality of life in patients with PDN. Also, it was associated with a perceived decline in physical activity, which had a mediating role in the association between catastrophizing and disability and quality of life, respectively. This study emphasizes the role of catastrophic thinking about pain and the experienced loss in daily activities due to PDN.
为全面了解疼痛性糖尿病神经病变（PDN）的负担，我们调查了疼痛灾难化与PDN患者残疾及生活质量之间的关系。此外，我们研究了身体活动和/或身体活动下降的中介作用。
这项基于问卷的横断面研究纳入了154例PDN患者。进行线性回归分析，并对年龄、性别、疼痛强度和胰岛素治疗进行校正，以评估疼痛灾难化（疼痛灾难化量表[PCS]）与结局变量残疾（疼痛残疾指数[PDI]）和生活质量（诺福克糖尿病神经病变生活质量问卷版[QOL-DN]）之间的关联。根据Baron和Kenny的方法，使用中介分析评估实际身体活动（身体活动评分量表[PARS]）和感知身体活动下降（PAD）的中介作用。
本研究纳入154例患者（62%为男性）。平均年龄为65.7岁（标准差=6.6）。PCS（M=20.3，标准差=13.1）与PDI（M=32.4，标准差=17.0；R=0.356，P<0.001）、QOL-DN（M=52.6，标准差=26.1；R=0.437，P<0.001）和PAD（M=7.4，标准差=5.7；R=0.087，P=0.045）显著相关。PAD分别在PCS与PDI和QOL-DN的关联中起部分中介作用。PCS与PARS无关联。
疼痛灾难化与PDN患者残疾增加和生活质量下降相关。此外，它与感知到的身体活动下降相关，而身体活动下降分别在灾难化与残疾和生活质量之间的关联中起中介作用。本研究强调了对疼痛的灾难性思维以及因PDN导致日常活动中经历的功能丧失的作用。
