J Oral Facial Pain Headache. 2018;32(4):409-417. doi: 10.11607/ofph.2067.
To investigate whether pain catastrophizing has not only direct effects as a predictor of pain-related interference but also indirect effects as a mediator in the relationship between psychological distress and pain interference and to examine the mediating roles of subtypes of catastrophizing (magnification, rumination, and helplessness) between psychological distress and interference.
This retrospective study included 815 patients with orofacial pain aged 18 to 81 years. All participants completed a set of self-administered questionnaires concerning pain interference (Brief Pain Inventory), psychological distress (Symptom Checklist-90-Revised), and pain catastrophizing (Pain Catastrophizing Scale) at the first consultation. The associations between these three variables were calculated using mediation path analysis.
Pain catastrophizing predicted pain interference. In addition, 34% of the variance in pain interference attributable to psychological distress was mediated by catastrophizing when controlling for pain duration and severity. The greatest portion of the mediating effect of catastrophizing was attributable to the helplessness component.
Within the limitations of cross-sectional studies, this study demonstrated that pain catastrophizing mediates the effects of psychological distress on pain interference in patients with orofacial pain. Most of the mediating effects were attributable to the helplessness component of pain catastrophizing. Cognitive behavioral therapy targeting pain catastrophizing, specifically helplessness, could potentially reduce pain-related disability in orofacial pain patients.
探讨疼痛灾难化不仅具有作为疼痛相关障碍预测因子的直接效应，而且还具有作为心理困扰与疼痛障碍之间关系的中介的间接效应，并检验灾难化的亚型（放大、沉思和无助）在心理困扰与障碍之间的中介作用。
本回顾性研究纳入了 815 名年龄在 18 至 81 岁之间的口腔颌面部疼痛患者。所有参与者在首次就诊时完成了一套自我管理问卷，内容涉及疼痛障碍（简明疼痛量表）、心理困扰（症状清单 90 修订版）和疼痛灾难化（疼痛灾难化量表）。使用中介路径分析计算这三个变量之间的关联。
疼痛灾难化预测了疼痛障碍。此外，在控制疼痛持续时间和严重程度后，心理困扰对疼痛障碍的 34%可归因于灾难化。灾难化的中介效应的最大部分归因于无助成分。
在横断面研究的限制内，本研究表明，疼痛灾难化中介了心理困扰对口腔颌面部疼痛患者疼痛障碍的影响。中介效应的大部分归因于疼痛灾难化的无助成分。针对疼痛灾难化，特别是无助的认知行为疗法，可能会降低口腔颌面部疼痛患者的疼痛相关残疾。
