Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
Health Psychology Section, King's College London, London, UK.
Aliment Pharmacol Ther. 2018 Mar;47(6):715-729. doi: 10.1111/apt.14493. Epub 2018 Jan 22.
Pain is a frequently reported symptom of inflammatory bowel disease (IBD) experienced by patients in active disease and remission. Psychological factors play a significant role in pain, but have not been systematically reviewed in IBD.
To review psychosocial factors associated with pain in adults diagnosed with IBD.
Electronic (PsycInfo, MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science), and hand-searching were conducted February-May 2017. Two authors carried out screening and data extraction.
Fifteen studies including 5539 IBD patients were identified. Emotional, cognitive-behavioural and personality factors were associated with IBD-pain. Depression and anxiety were the most commonly explored constructs, followed by perceived stress and pain catastrophising, all of which were positively associated with greater pain. Greater abdominal pain was associated with a concurrent mood disorder over fivefold (OR 5.76, 95% CI 1.39, 23.89). Coping strategies and pain fear avoidance correlated with pain levels. Perceived social support (r = .26) and internal locus of control (r = .33) correlated with less pain. Patients reporting pain in IBD remission more frequently had an existing diagnosis of a mood disorder, a chronic pain disorder and irritable bowel syndrome. Six studies controlled for disease activity, of which 4 found that psychosocial factors significantly predicted pain. The majority of studies (n = 10) were of high quality.
Psychosocial factors appear to play a significant role in IBD-pain. Further research is required to explore psychosocial constructs in relation to IBD-pain, with use of validated pain measures, large sample sizes and clearer characterisation of disease activity.
疼痛是炎症性肠病（IBD）患者在疾病活动期和缓解期常报告的症状。心理因素在疼痛中起重要作用，但尚未在 IBD 中系统地进行综述。
综述与成人 IBD 相关的疼痛的心理社会因素。
2017 年 2 月至 5 月，进行电子（PsycInfo、MEDLINE、EMBASE、Cochrane 图书馆、CINAHL、Web of Science）和手工检索。两位作者进行了筛选和数据提取。
确定了 15 项包括 5539 例 IBD 患者的研究。情绪、认知行为和人格因素与 IBD 疼痛相关。抑郁和焦虑是最常探讨的结构，其次是感知压力和疼痛灾难化，所有这些都与更大的疼痛呈正相关。腹痛更严重与并发心境障碍的相关性超过五倍（OR 5.76，95%CI 1.39，23.89）。应对策略和疼痛恐惧回避与疼痛水平相关。感知社会支持（r=0.26）和内部控制点（r=0.33）与疼痛减轻相关。报告 IBD 缓解期疼痛的患者更频繁地患有现有心境障碍、慢性疼痛障碍和肠易激综合征的诊断。有 6 项研究控制了疾病活动度，其中 4 项研究发现心理社会因素显著预测疼痛。大多数研究（n=10）的质量较高。
心理社会因素似乎在 IBD 疼痛中起重要作用。需要进一步研究以探讨与 IBD 疼痛相关的心理社会结构，使用验证的疼痛测量、大样本量和更清晰的疾病活动特征。
