Jensen Mark P, Solé Ester, Castarlenas Elena, Racine Mélanie, Roy Rubén, Miró Jordi, Cane Douglas
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain; Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain.
Scand J Pain. 2017 Oct;17:41-48. doi: 10.1016/j.sjpain.2017.07.002. Epub 2017 Jul 26.
Trait behavioral inhibition represents a tendency to react with negative emotions - primarily worry - to cues which signal potential threats. This tendency has been hypothesized by a two-factor model of chronic pain to have direct effects on psychological and physical function in individuals with chronic pain, as well as to influence the associations between pain-related maladaptive cognitions and function. Our aim was to test these hypothesized associations in a sample of individuals who were being screened for possible interdisciplinary chronic pain treatment.
Eighty-eight patients referred to an interdisciplinary chronic pain management program were administered measures of average pain intensity, trait behavioral inhibition, kinesiophobia, pain catastrophizing, depressive symptoms, and pain interference. We then performed two linear regression analyses to evaluate the direct effects of trait behavioral inhibition on depressive symptoms and pain interference and the extent to which behavioral inhibition moderated the associations between kinesiophobia and pain catastrophizing, and the criterion variables.
In partial support of the study hypotheses, the results showed significant (and independent) direct effects of trait behavioral inhibition on depressive symptoms, and behavioral inhibition moderated the association between kinesiophobia and depression, such that there were stronger associations between kinesiophobia and depressive symptoms in those with higher dispositional sensitivity to fear-inducing stimuli. However, neither direct nor moderating effects of behavioral inhibition emerged in the prediction of pain interference.
If replicated in additional studies, the findings would indicate that chronic pain treatments which target both reductions in maladaptive cognitions (to decrease the direct negative effects of these on depressive symptoms) and the individual's tendency to respond to pain with worry (as a way to buffer the potential effects of maladaptive cognitions on depressive symptoms) might be more effective than treatments that targeted only one of these factors.
Additional research is needed to further evaluate the direct and moderating effects of pain-related behavioral inhibition on function, as well as the extent to which treatments which target behavioral inhibition responses provide benefits to individuals with chronic pain.
特质行为抑制表现为对预示潜在威胁的线索产生消极情绪（主要是担忧）的一种倾向。慢性疼痛的双因素模型假定，这种倾向对慢性疼痛患者的心理和生理功能有直接影响，同时也会影响与疼痛相关的适应不良认知和功能之间的关联。我们的目的是在一个接受跨学科慢性疼痛治疗筛查的个体样本中检验这些假定的关联。
对88名转介至跨学科慢性疼痛管理项目的患者进行了平均疼痛强度、特质行为抑制、运动恐惧、疼痛灾难化、抑郁症状和疼痛干扰的测量。然后我们进行了两项线性回归分析，以评估特质行为抑制对抑郁症状和疼痛干扰的直接影响，以及行为抑制对运动恐惧与疼痛灾难化之间关联以及标准变量的调节程度。
部分支持研究假设，结果显示特质行为抑制对抑郁症状有显著（且独立）的直接影响，并且行为抑制调节了运动恐惧与抑郁之间的关联，即对恐惧诱发刺激具有较高特质敏感性的个体，运动恐惧与抑郁症状之间的关联更强。然而，在预测疼痛干扰时，行为抑制的直接或调节作用均未显现。
如果在其他研究中得到重复验证，这些发现将表明，针对减少适应不良认知（以降低其对抑郁症状的直接负面影响）以及个体对疼痛产生担忧的倾向（作为缓冲适应不良认知对抑郁症状潜在影响的一种方式）的慢性疼痛治疗，可能比仅针对其中一个因素的治疗更有效。
需要进一步研究以进一步评估与疼痛相关的行为抑制对功能的直接和调节作用，以及针对行为抑制反应的治疗对慢性疼痛患者有益的程度。
