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实验性压力疼痛评估:重测信度、收敛性和维度

Experimental pressure-pain assessments: Test-retest reliability, convergence and dimensionality.

作者信息

Lacourt Tamara E, Houtveen Jan H, van Doornen Lorenz J P

机构信息

Department of Clinical and Health Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.

出版信息

Scand J Pain. 2012 Jan 1;3(1):31-37. doi: 10.1016/j.sjpain.2011.10.003.


DOI:10.1016/j.sjpain.2011.10.003
PMID:29913770
Abstract

Introduction Experimental pain studies can provide unique insight into the dimensions of pain and into individual differences in pain responsiveness by controlling different aspects of pain-eliciting stimuli and pain measures. In experimental pain studies, pain responsiveness can be assessed as pain threshold, pain tolerance or pain ratings. The test-theoretical qualities of these different measures, however, have not yet been completely documented. In the current study, several of these qualities were investigated in a pain experiment applying different algometric techniques. The objective of the study was to investigate the reliability (test-retest) and the convergent validity (correspondence) of the different methods found in the literature of measuring pressure-pain threshold, and the interrelationship between pressure-pain threshold, pressure-pain tolerance, and pressure-pain ratings. Methods Sixty-six healthy female subjects were enrolled in the study. All pressure stimuli were applied by a trained investigator, using a digital algometer with a 1 cm2 rubber tip. Pressure-pain thresholds were assessed repeatedly on six different body points (i.e. left and right calf one third of total calf muscle length below the popliteal space), the lower back (5 cm left and right from the L3), and left and right forearm (thickest part of brachioradialis muscle). Next, pressure-pain tolerance was measured on the thumbnail of the non-dominant hand, followed by rating affective and sensory components (on visual analogue scales) of a stimulus at tolerance level. Last, affective and sensory ratings were obtained for two pressure intensities. Results With intraclass correlations above .75 for pain responses per body point, test-retest reliability was found to be good. However, values obtained from all first measurements were significantly higher as compared with the two succeeding ones. Convergent validity of pain thresholds across different body points was found to be high for all combinations assessed (Cronbach's alpha values >.80), but the highest for bilateral similar body parts (>.89). Finally, principal components analysis including measures of threshold, tolerance and pain ratings yielded a three-factor solution that explained 81.9% of the variance: Moderate-level stimulus appraisal & pain tolerance; Pain threshold; Tolerance-level stimulus appraisal. Conclusion and implications Findings of the current study were used to formulate recommendations for future algometric pain studies. Concerning pressure-pain threshold, it is recommended to exclude first measurements for every body point from further analyses, as these measurements were found to be consistently higher compared with the following measurements. Further, no more than two consecutive measurements (after the first measurement) are needed for a reliable mean threshold value per body point. When combining threshold values of several body points into one mean-aggregated threshold value, we suggest to combine bilateral similar points, as convergent validity values were highest for these combinations. The three-factor solution that was found with principal components analyses indicates that pressure-pain threshold, subjective ratings of moderate intensity stimuli, and subjective ratings of the maximum (tolerance) intensity are distinct aspects of pain responsiveness. It is therefore recommended to include a measure of each of these three dimensions of pain when assessing pressure pain responsiveness. Some limitations of our study are discussed.

摘要

引言 实验性疼痛研究可以通过控制疼痛诱发刺激和疼痛测量的不同方面,为疼痛的维度以及疼痛反应的个体差异提供独特的见解。在实验性疼痛研究中,疼痛反应可以通过疼痛阈值、疼痛耐受力或疼痛评分来评估。然而,这些不同测量方法的测试理论特性尚未得到充分记录。在本研究中,通过应用不同的疼痛测量技术在一个疼痛实验中对其中一些特性进行了调查。本研究的目的是调查文献中发现的测量压力疼痛阈值的不同方法的可靠性(重测)和收敛效度(对应关系),以及压力疼痛阈值、压力疼痛耐受力和压力疼痛评分之间的相互关系。 方法 66名健康女性受试者参与了本研究。所有压力刺激均由一名经过培训的研究人员使用带有1平方厘米橡胶头的数字压力痛觉计施加。在六个不同的身体部位(即左右小腿,在腘窝下方小腿肌肉总长度的三分之一处)、下背部(L3水平左右5厘米处)以及左右前臂(肱桡肌最厚处)反复评估压力疼痛阈值。接下来,在非优势手的拇指甲上测量压力疼痛耐受力,然后在耐受水平对刺激的情感和感觉成分进行评分(使用视觉模拟量表)。最后,对两种压力强度进行情感和感觉评分。 结果 每个身体部位的疼痛反应的组内相关性高于0.75,重测可靠性良好。然而,与随后的两次测量相比,所有第一次测量获得的值显著更高。在所有评估的组合中,不同身体部位的疼痛阈值的收敛效度都很高(克朗巴哈系数值>.80),但双侧相似身体部位的收敛效度最高(>.89)。最后,包括阈值、耐受力和疼痛评分测量在内的主成分分析产生了一个三因素解决方案,该方案解释了81.9%的方差:中等强度刺激评估和疼痛耐受力;疼痛阈值;耐受水平刺激评估。 结论与启示 本研究的结果被用于为未来的疼痛测量研究制定建议。关于压力疼痛阈值,建议在进一步分析中排除每个身体部位的第一次测量,因为发现这些测量与随后测量相比始终更高。此外,每个身体部位获得可靠的平均阈值所需的连续测量(第一次测量之后)不超过两次。当将几个身体部位的阈值组合成一个平均汇总阈值时,我们建议组合双侧相似部位,因为这些组合的收敛效度值最高。主成分分析发现的三因素解决方案表明,压力疼痛阈值、中等强度刺激的主观评分和最大(耐受)强度的主观评分是疼痛反应的不同方面。因此,在评估压力疼痛反应时,建议包括这三个疼痛维度中每个维度的测量。我们研究的一些局限性也进行了讨论。

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