Pfeifer Ann-Christin, Penedo Juan Martin Gómez, Ehrenthal Johannes C, Neubauer Eva, Amelung Dorothee, Schroeter Corinna, Schiltenwolf Marcus
Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Heidelberg, Germany,
Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany,
J Pain Res. 2018 Nov 1;11:2653-2662. doi: 10.2147/JPR.S165487. eCollection 2018.
Insecure attachment patterns are related to the onset and development of chronic pain. However, it is less documented on how short- and long-term effects of pain therapy might differ with the attachment style in interaction with specific pain conditions. We therefore examined how two different groups of chronic pain patients differ in their treatment trajectories and in regard to attachment.
N=85/76/67 (T1/T2/T3) patients with medically unexplained musculoskeletal pain (UMP group) were compared to n=89/76/56 patients with joint pain from osteoarthritis (OA group), using multilevel modeling. UMP patients received a multimodal pain program, and OA patients received surgery. Pain intensity before (T1) and after (T2) treatment and at a 6 months follow-up (T3) was assessed by using a visual analog scale of pain.
Pain patients report a significant reduction in pain intensity upon the completion of the treatment compared to T1. Over the next 6 months, the pain intensity has further declined for patients with low attachment anxiety. In contrast, patients with highly anxious attachment report an increase in pain intensity. This main effect of anxious attachment on pain is significant when predicting changes both in acute treatment and during follow-up while controlling for group effect. In addition, there is also an interactive effect of group by avoidant attachment. In the UMP group, high scores in avoidant attachment were associated with the lower reduction in pain severity, while in the OA group, high scores in attachment avoidance were associated with a steeper reduction in pain severity.
The results indicate that insecurely attached patients with pain symptoms only benefit from a multimodal pain therapy in limited ways in regard to posttreatment trajectories. Maintaining positive results over a period of 6 months is a challenge, compared with securely attached patients.
The results of this study suggest the importance of direct and indirect mechanisms of attachment and its relevance for the management of pain experiences. Therefore, to include the individual attachment patterns in the treatment may be a promising way to enhance the treatment prospects.
不安全依恋模式与慢性疼痛的发生和发展有关。然而，关于疼痛治疗的短期和长期效果如何因依恋风格与特定疼痛状况的相互作用而有所不同，相关文献记载较少。因此，我们研究了两组不同的慢性疼痛患者在治疗轨迹和依恋方面的差异。
采用多水平模型，将N = 85/76/67（T1/T2/T3）例患有医学上无法解释的肌肉骨骼疼痛的患者（UMP组）与n = 89/76/56例骨关节炎关节疼痛患者（OA组）进行比较。UMP患者接受多模式疼痛治疗方案，OA患者接受手术。使用视觉模拟疼痛量表评估治疗前（T1）、治疗后（T2）以及6个月随访时（T3）的疼痛强度。
与T1相比，疼痛患者在治疗结束时报告疼痛强度显著降低。在接下来的6个月里，依恋焦虑程度低的患者疼痛强度进一步下降。相比之下，依恋焦虑程度高的患者报告疼痛强度增加。在控制组效应的同时，预测急性治疗和随访期间的变化时，焦虑依恋对疼痛的这一主要影响是显著的。此外，回避依恋还存在组间交互效应。在UMP组中，回避依恋得分高与疼痛严重程度降低幅度较小相关，而在OA组中，回避依恋得分高与疼痛严重程度下降幅度较大相关。
结果表明，有疼痛症状的不安全依恋患者在治疗后轨迹方面仅能以有限的方式从多模式疼痛治疗中获益。与安全依恋的患者相比，在六个月的时间内维持积极效果是一项挑战。
本研究结果表明依恋的直接和间接机制的重要性及其与疼痛体验管理的相关性。因此，在治疗中纳入个体依恋模式可能是提高治疗前景的一种有前景的方法。
