Lillis Jason, Graham Thomas J, Seng Elizabeth K, Lipton Richard B, Pavlović Jelena M, Rathier Lucille, Roth Julie, O'Leary Kevin C, Bond Dale S
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA.
Department of Neurology, Albert Einstein College of Medicine, Ferkauf Graduate School of Psychology, Yeshiva University, New York City, NY, USA.
Headache. 2017 May;57(5):709-718. doi: 10.1111/head.13058. Epub 2017 Mar 13.
Pain acceptance involves willingness to experience pain and engaging in valued activities while pain is present. Though pain acceptance could limit both headache-related disability and pain interference in individuals with migraine, few studies have addressed this issue. This study evaluated whether higher levels of total pain acceptance and its two subcomponents, pain willingness and activity engagement, were associated with lower levels of headache-related impairment in women who had both migraine and overweight/obesity.
In this cross-sectional study, participants seeking weight loss and headache relief in the Women's Health and Migraine trial completed baseline measures of pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]), headache-related disability (Headache Impact Test-6), and pain interference (Brief Pain Inventory). Migraine headache frequency and pain intensity were assessed daily via smartphone diary. Using CPAQ total and subcomponent (pain willingness and activity engagement) scores, headache frequency, pain intensity, and body mass index (BMI) as predictors in linear regression, headache-related disability, and pain interference were modeled as outcomes.
On average, participants (n = 126; age = 38.5 ± 8.2 years; BMI = 35.3 ± 6.6 kg/m ) reported 8.4 ± 4.7 migraine days/month and pain intensity of 6.0 ± 1.5 on a 0-10 scale on headache days. After correcting for multiple comparisons (adjusted α = .008), pain willingness was independently associated with both lower headache-related disability (P < .001; β = -0.233) and pain interference (P < .001; β = -0.261). Activity engagement was not associated with headache-related disability (P = .128; β = -0.138) and pain interference (P = .042; β = -0.154). CPAQ total score was not associated with headache-related disability (P = .439; β = 0.066) and pain interference (P = .305; β = 0.074). Pain intensity was significantly associated with outcomes in all analyses (Ps < .001; βs 0.343-0.615).
Higher pain willingness, independent of degree of both migraine severity and overweight, is associated with lower headache-related disability and general pain interference in treatment-seeking women with migraine and overweight/obesity. Future studies are needed to clarify direction of causality and test whether strategies designed to help women increase pain willingness, or relinquish ineffective efforts to control pain, can improve functional outcomes in women who have migraine and overweight/obesity.
疼痛接纳涉及在疼痛存在时愿意体验疼痛并参与有价值的活动。尽管疼痛接纳可能会限制偏头痛患者与头痛相关的残疾和疼痛干扰，但很少有研究涉及这个问题。本研究评估了较高水平的总体疼痛接纳及其两个子成分，即疼痛意愿和活动参与，是否与患有偏头痛且超重/肥胖的女性较低水平的头痛相关损伤有关。
在这项横断面研究中，参与女性健康与偏头痛试验以寻求减肥和缓解头痛的参与者完成了疼痛接纳（慢性疼痛接纳问卷[CPAQ]）、头痛相关残疾（头痛影响测试-6）和疼痛干扰（简明疼痛量表）的基线测量。通过智能手机日记每日评估偏头痛发作频率和疼痛强度。使用CPAQ总分及其子成分（疼痛意愿和活动参与）得分、头痛频率、疼痛强度和体重指数（BMI）作为线性回归中的预测因素，将头痛相关残疾和疼痛干扰作为结果进行建模。
平均而言，参与者（n = 126；年龄 = 38.5 ± 8.2岁；BMI = 35.3 ± 6.6 kg/m²）报告每月偏头痛天数为8.4 ± 4.7天，头痛日疼痛强度在0-10分制上为6.0 ± 1.5。在对多重比较进行校正（调整后的α = 0.008）后，疼痛意愿与较低的头痛相关残疾（P < 0.001；β = -0.233）和疼痛干扰（P < 0.001；β = -0.261）均独立相关。活动参与与头痛相关残疾（P = 0.128；β = -0.138）和疼痛干扰（P = 0.042；β = -0.154）无关。CPAQ总分与头痛相关残疾（P = 0.439；β = 0.066）和疼痛干扰（P = 0.305；β = 0.074）无关。在所有分析中，疼痛强度均与结果显著相关（P < 0.001；β为0.343 - 0.615）。
较高的疼痛意愿，独立于偏头痛严重程度和超重程度，与寻求治疗的患有偏头痛且超重/肥胖的女性较低的头痛相关残疾和一般疼痛干扰有关。未来需要进行研究以阐明因果关系方向，并测试旨在帮助女性提高疼痛意愿或放弃控制疼痛的无效努力的策略是否能改善患有偏头痛且超重/肥胖的女性的功能结局。
