Shaygan Maryam, Böger Andreas, Kröner-Herwig Birgit
Community Based Psychiatric Care Research Centre, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
Pain Management Clinic at the Red Cross Hospital, Kassel, Germany.
J Pain Res. 2019 Jun 13;12:1879-1890. doi: 10.2147/JPR.S197533. eCollection 2019.
Reduction in pain following multidisciplinary treatment is most often associated with a reduction in disability. To further elaborate the relationship between pain intensity and disability, the present study investigated three main questions: first, whether multidisciplinary treatment leads to a significant improvement in pain, disability and psychological variables (depression, pain acceptance and catastrophizing). Second, it was examined whether pain reduction may account for significant changes in the psychological variables (pre- to follow-up change scores). Finally, it was analyzed whether the psychological changes mediate the association between reduction in pain and in disability after controlling for age, sex and pain history.
Patients suffering from chronic musculoskeletal pain (n=279) attended a German inpatient multidisciplinary program lasting 15 consecutive days on average, with self-report data collected at pretreatment, posttreatment and three-month follow-up.
Repeated measures ANOVAs showed a significant improvement in pain intensity, disability, pain acceptance, catastrophizing and depression at posttreatment and follow-up. Univariate regression analyses revealed that changes in pain intensity accounted for significant changes in depression, pain catastrophizing and pain acceptance (pre- to follow-up change scores). The results of Multiple Mediation Procedure showed that pain reduction did affect reduction in disability through improvement of depression, catastrophizing and acceptance.
Our findings support a cognitive-behavioral model of pain that posits an important role for pain-related cognitive and emotional processes in long-term outcomes following multidisciplinary pain treatment, in particular for the modulation of disability due to pain. The results add evidence to the notion that pain-related cognitions are dynamic features varying over time dependent on the internal situation.
The current findings are relevant to the management of patients with musculoskeletal pain. The results support the notion that, in contrast with the view of enduring personality traits, pain-related cognitions and emotions reflect a situational response that varies over time.
多学科治疗后疼痛减轻通常与残疾程度降低相关。为进一步阐述疼痛强度与残疾之间的关系，本研究调查了三个主要问题：第一，多学科治疗是否能显著改善疼痛、残疾及心理变量（抑郁、疼痛接纳和灾难化思维）。第二，研究疼痛减轻是否可解释心理变量的显著变化（治疗前至随访的变化分数）。最后，分析在控制年龄、性别和疼痛病史后，心理变化是否介导疼痛减轻与残疾程度降低之间的关联。
患有慢性肌肉骨骼疼痛的患者（n = 279）参加了一个平均持续15天的德国住院多学科项目，并在治疗前、治疗后及三个月随访时收集了自我报告数据。
重复测量方差分析显示，治疗后及随访时疼痛强度、残疾程度、疼痛接纳、灾难化思维和抑郁均有显著改善。单变量回归分析表明，疼痛强度的变化可解释抑郁、疼痛灾难化思维和疼痛接纳的显著变化（治疗前至随访的变化分数）。多重中介程序的结果表明，疼痛减轻确实通过改善抑郁、灾难化思维和接纳来影响残疾程度的降低。
我们的研究结果支持一种疼痛的认知行为模型，该模型认为疼痛相关的认知和情感过程在多学科疼痛治疗后的长期结果中起重要作用，特别是对因疼痛导致的残疾的调节作用。这些结果为疼痛相关认知是随时间变化的动态特征这一观点提供了证据，其变化取决于内部状况。
目前的研究结果与肌肉骨骼疼痛患者的管理相关。结果支持这样一种观点，即与持久人格特质的观点相反，疼痛相关的认知和情感反映了一种随时间变化的情境反应。
