Schütze Robert, Rees Clare, Slater Helen, Smith Anne, O'Sullivan Peter
School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia.
School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
Br J Health Psychol. 2017 Sep;22(3):463-480. doi: 10.1111/bjhp.12240. Epub 2017 Apr 3.
Pain catastrophizing is widely studied in quantitative pain research because of its strong link with poor pain outcomes, although the exact nature of this construct remains unclear. Focusing on its ruminative dimension, the present qualitative study aimed to explore a nascent aspect of pain catastrophizing - metacognition - by documenting people's attitudes towards rumination and examining how these metacognitions might influence the course it takes.
Qualitative interview study.
Semi-structured interviews were conducted in a tertiary care setting with 15 adults experiencing chronic (≥6 months) low back pain who scored highly (≥30) on the Pain Catastrophising Scale. Transcripts were analysed using interpretative phenomenological analysis.
The first aim of documenting pain metacognitions revealed both positive (e.g., 'thinking helps me to cope') and negative (e.g., 'rumination is uncontrollable') attitudes towards pain rumination. These were often held simultaneously, creating internal conflict. The second aim of exploring the influence of metacognition on rumination showed that both negative and positive metacognitions could fuel perseverative thinking. However, more nuanced negative metacognitions (e.g., 'worry is pointless') could help to end episodes of rumination by motivating the use of concrete problem-solving or active coping behaviours.
While most participants described pain rumination as uncontrollable and harmful, dwelling on pain could be helpful when focused on tangible and solvable problems, thereby translating into adaptive coping behaviours that eventually interrupt rumination. Future treatments may be more effective if they are based on individualized formulations of pain catastrophizing that focus on its perseverative nature and implicit function. Statement of contribution What is already known on this subject? Chronic pain affects one in five people, and psychological coping responses are key targets within gold standard biopsychosocial interventions. People who have elevated pain catastrophizing tend to have worse pain outcomes, including increased pain, disability, and emotional distress. What people believe about their own thinking (i.e., their metacognitions) influences how much they worry or ruminate. What does this study add? This is the first qualitative study exploring metacognitions in people with chronic pain and the first to target a purposive sample of people with elevated pain catastrophizing. People with elevated pain catastrophizing often see rumination as uncontrollable and harmful but may simultaneously believe it helps them to solve problems or feel prepared for future threats. Pain catastrophizing is not a stable and enduring trait but fluctuates both within and across individuals in response to pain, context, metacognitive beliefs about rumination, and coping behaviours.
尽管疼痛灾难化的确切本质仍不清楚，但由于它与不良疼痛结果密切相关，因此在定量疼痛研究中得到了广泛研究。本定性研究聚焦于其沉思维度，旨在通过记录人们对沉思的态度并考察这些元认知如何可能影响沉思的过程，来探索疼痛灾难化的一个新方面——元认知。
定性访谈研究。
在三级医疗环境中对15名患有慢性（≥6个月）下背痛且在疼痛灾难化量表上得分较高（≥30分）的成年人进行了半结构化访谈。使用解释现象学分析对访谈记录进行分析。
记录疼痛元认知的首要目标揭示了对疼痛沉思既有积极态度（例如，“思考帮助我应对”）也有消极态度（例如，“沉思是无法控制的”）。这些态度常常同时存在，从而产生内心冲突。探索元认知对沉思影响的第二个目标表明，消极和积极的元认知都可能助长持续思考。然而，更细微的消极元认知（例如，“担忧毫无意义”）可以通过促使人们采用具体的解决问题或积极应对行为来帮助结束沉思。
虽然大多数参与者将疼痛沉思描述为无法控制且有害的，但当专注于切实可行且可解决的问题时，对疼痛的反复思考可能会有所帮助，从而转化为适应性应对行为，最终中断沉思。如果未来的治疗基于针对疼痛灾难化的个性化方案，聚焦于其持续思考的本质和隐含功能，可能会更有效。贡献声明关于该主题已知的信息有哪些？慢性疼痛影响五分之一的人，心理应对反应是金标准生物心理社会干预的关键目标。疼痛灾难化程度较高的人往往有更差的疼痛结果，包括疼痛加剧、残疾和情绪困扰。人们对自己思维的看法（即他们的元认知）会影响他们担忧或沉思的程度。本研究增加了什么内容？这是第一项探索慢性疼痛患者元认知的定性研究，也是第一项针对有较高疼痛灾难化程度的目标样本的研究。疼痛灾难化程度较高的人通常认为沉思是无法控制且有害的，但可能同时认为它有助于他们解决问题或为未来威胁做好准备。疼痛灾难化不是一种稳定持久的特质，而是会因疼痛、情境、对沉思的元认知信念以及应对行为而在个体内部和个体之间波动。
