Boggero Ian A, Rojas-Ramirez Marcia V, Carlson Charles R
*Department of Psychology †College of Public Health, University of Kentucky, Lexington, KY.
Clin J Pain. 2017 Mar;33(3):231-237. doi: 10.1097/AJP.0000000000000391.
Fatigue is known to be a pathway through which depression, psychological distress, pain intensity, and sleep disturbance influence pain interference, but the independent effects of fatigue on pain interference after controlling for these variables remains unknown. In addition, no study to date has tested whether fatigue subtypes of general fatigue, mental fatigue, emotional fatigue, physical fatigue, or vigor differentially predict pain interference.
The current study tested these associations using archival medical data of 2133 chronic orofacial pain patients, who completed a battery of psychological questionnaires at the time of their first appointment at an orofacial pain clinic.
Hierarchical linear regression analysis revealed that after controlling for depression, psychological distress, sleep disturbance, pain intensity, and demographic variables, fatigue predicted higher pain interference (B=0.70, SE=0.17, P<0.001, η=0.01). Physical fatigue (B=1.70, SE=0.48, P<0.001, η=0.01) and vigor (B=-3.24, SE=0.47, P<0.001, η=0.03) were independently associated with pain interference after controlling for the aforementioned variables.
The findings suggest that fatigue is an important independent predictor of pain interference and not merely a mediator. These findings also suggest that not all fatigue is created equal. Interventions aimed at reducing pain interference should target specific fatigue symptoms of physical fatigue and vigor. Future research investigating the independent associations of fatigue subtypes on pain outcomes may help clarify the nature of the interrelationships between pain and fatigue.
疲劳是抑郁、心理困扰、疼痛强度和睡眠障碍影响疼痛干扰的一种途径，但在控制这些变量后，疲劳对疼痛干扰的独立影响尚不清楚。此外，迄今为止，尚无研究测试一般疲劳、精神疲劳、情绪疲劳、身体疲劳或活力等疲劳亚型是否对疼痛干扰有不同的预测作用。
本研究使用2133名慢性口面部疼痛患者的档案医学数据测试了这些关联，这些患者在首次到口面部疼痛诊所就诊时完成了一系列心理问卷。
分层线性回归分析显示，在控制了抑郁、心理困扰、睡眠障碍、疼痛强度和人口统计学变量后，疲劳预示着更高的疼痛干扰（B=0.70，标准误=0.17，P<0.001，η=0.01）。在控制上述变量后，身体疲劳（B=1.70，标准误=0.48，P<0.001，η=0.01）和活力（B=-3.24，标准误=0.47，P<0.001，η=0.03）与疼痛干扰独立相关。
研究结果表明，疲劳是疼痛干扰的一个重要独立预测因素，而不仅仅是一个中介因素。这些结果还表明，并非所有疲劳都是相同的。旨在减少疼痛干扰的干预措施应针对身体疲劳和活力等特定的疲劳症状。未来研究疲劳亚型与疼痛结果之间的独立关联，可能有助于阐明疼痛与疲劳之间相互关系的本质。
