Behavioural Research, Association of Dutch Burn Centers, Beverwijk, The Netherlands.
Clinical Psychology, Utrecht University, The Netherlands.
Eur J Pain. 2018 Jul;22(6):1151-1159. doi: 10.1002/ejp.1203. Epub 2018 Mar 9.
Pain and posttraumatic stress disorder (PTSD) symptoms are significant problems in the aftermath of a burn injury and they often co-occur. Catastrophizing has been linked to both phenomena. The aim of this study was to investigate the underlying role of catastrophizing in PTSD symptoms and pain following burns.
This prospective study included 216 patients with burns. PTSD symptoms and pain were measured during hospitalization (T1) and 6 (T2) and 12 months (T3) postburn. The Impact of Event Scale-Revised (IES-R) indexed PTSD symptoms. Acute pain (T1) was the mean pain during the first two weeks of hospitalization measured using an 11-point graphic numeric rating scale. Chronic pain was indexed using the single item 'average' pain from the Brief Pain Inventory (BPI). Catastrophizing was measured at T1 and T2 using the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analysed using structural equation modelling (SEM).
The results showed that T2 catastrophizing mediated between acute and chronic PTSD symptoms, and T3 pain. Furthermore, the study revealed significant associations between catastrophizing, PTSD symptoms and pain at the respective measurements, and significant longitudinal associations between the constructs.
A negative cognitive-affective response to a burn event, such as catastrophizing, mediated the relationship between acute and chronic PTSD symptoms and later chronic pain. Screening for catastrophizing and acute PTSD symptoms is recommended to identify persons at risk for chronic PTSD symptoms and pain.
The identification of individuals who have the tendency to catastrophize may assist in finding those at risk for development of both chronic PTSD symptoms and chronic pain. Individuals may benefit from early psychological therapy focussing on catastrophizing and acute PTSD symptoms that may ameliorate both chronic PTSD symptoms and pain.
疼痛和创伤后应激障碍（PTSD）症状是烧伤后的严重问题，且常同时发生。灾难化思维与这两种现象均有关联。本研究旨在探讨灾难化思维在烧伤后 PTSD 症状和疼痛中的潜在作用。
本前瞻性研究纳入了 216 名烧伤患者。在住院期间（T1）以及烧伤后 6 个月（T2）和 12 个月（T3）测量 PTSD 症状和疼痛。修订后的事件影响量表（IES-R）用于评估 PTSD 症状。急性疼痛（T1）为住院前两周的平均疼痛，采用 11 点图形数字评分量表进行测量。慢性疼痛采用简明疼痛量表（BPI）中的单项“平均”疼痛进行评估。在 T1 和 T2 时使用认知情绪调节问卷（CERQ）测量灾难化思维。使用结构方程模型（SEM）进行数据分析。
结果显示，T2 灾难化思维在急性和慢性 PTSD 症状与 T3 疼痛之间起中介作用。此外，研究还发现了灾难化思维、PTSD 症状和疼痛在各自测量时的显著相关性，以及各结构之间的显著纵向相关性。
对烧伤事件的消极认知-情感反应，如灾难化思维，介导了急性和慢性 PTSD 症状与随后慢性疼痛之间的关系。建议对灾难化思维和急性 PTSD 症状进行筛查，以识别出有发生慢性 PTSD 症状和疼痛风险的个体。
识别出有灾难化思维倾向的个体可能有助于发现那些有发展为慢性 PTSD 症状和慢性疼痛风险的个体。早期心理治疗针对灾难化思维和急性 PTSD 症状可能会减轻慢性 PTSD 症状和疼痛。
