Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Trauma Surgery, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Ann Behav Med. 2017 Aug;51(4):547-554. doi: 10.1007/s12160-017-9877-1.
Patients who present to hand surgery practices are at increased risk of psychological distress, pain, and disability. Greater catastrophic thinking about pain is associated with greater pain intensity, and initial evidence suggest that, together, catastrophic thinking about pain and cognitive fusion (i.e., interpretation of thoughts as true) are associated with poorer pain outcomes.
We tested whether cognitive fusion or catastrophic thinking interacts in relation to pain and upper extremity physical function among patients seeking care from a hand surgeon.
Patients (N = 110; mean age= 47.51; 59% women) presenting to an outpatient hand surgery practice completed computerized measures of sociodemographics, pain intensity, cognitive fusion, catastrophic thinking about pain, and upper extremity function.
ANCOVA revealed an interaction between cognitive fusion and catastrophic thinking about pain with respect to pain intensity and upper extremity function (ps < .01). Participants who scored high on both cognitive fusion and catastrophic thinking about pain reported the greatest levels of pain, relative to those who scored high on a single measure. The lowest levels of upper extremity function were also observed among those who scored high on both catastrophic thinking about pain and cognitive fusion. A similar pattern of results was observed when we tested each catastrophizing subscale individually.
Maladaptive cognitions about pain (i.e., catastrophic thinking) may be particularly problematic when interpreted as representative of reality (i.e., cognitive fusion). Psychosocial interventions addressing catastrophic thinking about pain and cognitive fusion concurrently merit investigation among people with hand and upper extremity illness.
就诊于手外科的患者存在心理困扰、疼痛和残疾的风险增加。对疼痛的灾难性思维越多，疼痛强度越大，初步证据表明，对疼痛的灾难性思维和认知融合（即，将思维解释为真实）共同与更差的疼痛结局相关。
我们测试了在寻求手外科医生治疗的患者中，认知融合或灾难性思维是否与疼痛和上肢身体功能相互作用。
110 名患者（平均年龄=47.51 岁；59%为女性）就诊于手外科门诊，完成了关于社会人口统计学、疼痛强度、认知融合、对疼痛的灾难性思维以及上肢功能的计算机化测量。
ANCOVA 显示认知融合和对疼痛的灾难性思维之间存在交互作用，与疼痛强度和上肢功能有关（p<0.01）。在认知融合和对疼痛的灾难性思维上均得分较高的参与者报告的疼痛程度最高，与仅在单一测量上得分较高的参与者相比。在对疼痛的灾难性思维和认知融合上均得分较高的参与者的上肢功能也最低。当我们分别测试每个灾难化亚量表时，观察到类似的结果模式。
对疼痛的适应不良认知（即灾难性思维）在被解释为代表现实时（即认知融合）可能特别成问题。针对疼痛的灾难性思维和认知融合进行的心理社会干预在手部和上肢疾病患者中值得进一步研究。
