Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA.
Pain. 2017 Sep;158(9):1687-1696. doi: 10.1097/j.pain.0000000000000964.
Chronic pain is a pervasive condition that is complicated by economic, educational, and racial disparities. This study analyzes key factors associated with chronic pain within an understudied and underserved population. The sample is characterized by a triple disparity with respect to income, education/literacy, and racial barriers that substantially increase the vulnerability to the negative consequences of chronic pain. The study examined the pretreatment data of 290 participants enrolled in the Learning About My Pain trial, a randomized controlled comparative effectiveness trial of psychosocial interventions (B.E.T., Principal Investigator, Patient-Centered Outcomes Research Institute Contract No. 941; clinicaltrials.gov identifier NCT01967342) for chronic pain. Hierarchical multiple regression analyses evaluated the relationships among sociodemographic (sex, age, race, poverty status, literacy, and education level) and psychological (depressive symptoms and pain catastrophizing) variables and pain interference, pain severity, and disability. The indirect effects of depressive symptoms and pain catastrophizing on the sociodemographic and pain variables were investigated using bootstrap resampling. Reversed mediation models were also examined. Results suggested that the experience of chronic pain within this low-income sample is better accounted for by psychological factors than sex, age, race, poverty status, literacy, and education level. Depressive symptoms and pain catastrophizing mediated the relationships between age and pain variables, whereas pain catastrophizing mediated the effects of primary literacy and poverty status. Some reversed models were equivalent to the hypothesized models, suggesting the possibility of bidirectionality. Although cross-sectional findings cannot establish causality, our results highlight the critical role psychological factors play in individuals with chronic pain and multiple health disparities.
慢性疼痛是一种普遍存在的疾病，其复杂性受到经济、教育和种族差异的影响。本研究分析了在一个研究不足和服务不足的人群中与慢性疼痛相关的关键因素。该样本具有三重差异，即收入、教育/读写能力和种族障碍，这大大增加了对慢性疼痛负面后果的脆弱性。本研究检查了 290 名参加学习我的疼痛试验的参与者的预处理数据，这是一项心理社会干预（B.E.T.，首席研究员，患者中心结果研究所合同号 941；clinicaltrials.gov 标识符 NCT01967342）的随机对照比较有效性试验慢性疼痛。分层多元回归分析评估了社会人口统计学（性别、年龄、种族、贫困状况、读写能力和教育水平）和心理（抑郁症状和疼痛灾难化）变量与疼痛干扰、疼痛严重程度和残疾之间的关系。使用自举重采样研究了抑郁症状和疼痛灾难化对社会人口统计学和疼痛变量的间接影响。还检查了反向中介模型。结果表明，在这个低收入样本中，慢性疼痛的体验更多地归因于心理因素，而不是性别、年龄、种族、贫困状况、读写能力和教育水平。抑郁症状和疼痛灾难化介导了年龄和疼痛变量之间的关系，而疼痛灾难化则介导了主要读写能力和贫困状况的影响。一些反向模型与假设模型等效，表明存在双向性的可能性。尽管横断面研究结果不能确定因果关系，但我们的结果强调了心理因素在慢性疼痛和多种健康差异个体中的关键作用。
