Söderlund Anne, Sandborgh Maria, Johansson Ann-Christin
a Department of Physiotherapy , Mälardalen University , Västerås , Sweden.
Physiother Theory Pract. 2017 May;33(5):376-385. doi: 10.1080/09593985.2017.1307890. Epub 2017 Apr 11.
Pain perception is influenced by several cognitive and behavioral factors of which some identified as mediators are important in pain management. We studied the mediating role of control over pain and ability to decrease pain in relation to functional self-efficacy, catastrophizing, and pain-related disability in patients with Whiplash-Associated Disorders, (WAD). Further, if the possible mediating impact differs over time from acute to three and 12 months after an accident, cross-sectional and prospective design was used, and 123 patients with WAD were included. Regression analyses were conducted to examine the mediating effect. The results showed that control over pain and ability to decrease pain were not mediators between self-efficacy, catastrophizing, and disability. Self-efficacy had a larger direct effect on pain-related disability compared to catastrophizing. Thus, healthcare staff should give priority to increase patients' self-efficacy, decrease catastrophic thinking, and have least focus on control over pain or ability to decrease pain.
疼痛感知受多种认知和行为因素影响，其中一些已被确定为中介因素，在疼痛管理中很重要。我们研究了在挥鞭样损伤相关疾病（WAD）患者中，对疼痛的控制和减轻疼痛的能力在功能自我效能感、灾难化思维及疼痛相关残疾方面的中介作用。此外，考虑到从事故发生后的急性期到三个月及十二个月，可能的中介影响是否随时间变化，我们采用了横断面和前瞻性设计，纳入了123例WAD患者。进行回归分析以检验中介效应。结果显示，对疼痛的控制和减轻疼痛的能力并非自我效能感、灾难化思维和残疾之间的中介因素。与灾难化思维相比，自我效能感对疼痛相关残疾的直接影响更大。因此，医护人员应优先提高患者的自我效能感，减少灾难化思维，而对疼痛控制或减轻疼痛能力的关注应最少。
