School of Psychology, Curtin University, Perth, Australia.
School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
Eur J Pain. 2020 Jan;24(1):223-233. doi: 10.1002/ejp.1479. Epub 2019 Oct 3.
Pain catastrophizing is linked to a range of negative health and treatment outcomes, although debate continues about how best to define and treat it, since most interventions produce only modest benefit. This study aimed to contribute to theory-driven development of these treatments by exploring the role of perseverative thinking in pain catastrophizing, along with the higher order beliefs, called metacognitions that might shape it.
An Internet sample of 510 people with chronic pain (≥3 months), who mostly (54.9%) had clinical levels of catastrophizing, completed self-report measures of pain intensity, disability, perseverative thinking, pain catastrophizing, depression, anxiety, and pain metacognition. Regression-based moderated mediation analysis tested the conditional indirect effect of pain intensity on pain catastrophizing via perseverative thinking at varying levels of unhelpful pain metacognition.
Perseverative thinking partially mediated the effect of pain intensity on pain catastrophizing, accounting for 20% of the total effect. This indirect effect was conditional on both positive and negative metacognition. Higher levels of both forms of unhelpful metacognition strengthened the indirect effect, which was not significant below the 50th percentile for positive metacognitions or below the 60th percentile for negative metacognitions.
Strongly believing that thinking about pain helps you solve problems or cope with pain (positive metacognition), or that it is harmful and uncontrollable (negative metacognition), can increase the amount you worry or ruminate as pain increases. This is associated with increased pain catastrophizing. Identifying and modifying these unhelpful pain metacognitions may improve treatments for pain catastrophizing and thereby chronic pain generally.
This study shows that perseverative thinking (worry and rumination) mediates the relationship between pain intensity and catastrophizing. Consistent with metacognitive theory, this association is also moderated by unhelpful beliefs about worry and rumination. Pain metacognitions could become new therapeutic targets to help improve psychological treatments for pain-related distress, which are currently only modestly effective.
疼痛灾难化与一系列负面的健康和治疗结果有关，尽管关于如何最好地定义和治疗它的争论仍在继续，因为大多数干预措施只能产生适度的效果。本研究旨在通过探索坚持性思维在疼痛灾难化中的作用，以及可能影响它的更高阶信念，即元认知，为这些治疗方法的理论驱动发展做出贡献。
一项针对 510 名慢性疼痛（≥3 个月）患者的互联网样本，其中大多数（54.9%）存在临床水平的灾难化，完成了自我报告的疼痛强度、残疾、坚持性思维、疼痛灾难化、抑郁、焦虑和疼痛元认知的测量。基于回归的中介调节分析测试了疼痛强度通过坚持性思维对疼痛灾难化的条件间接影响，在不同程度的无益疼痛元认知下。
坚持性思维部分中介了疼痛强度对疼痛灾难化的影响，占总效应的 20%。这种间接效应取决于积极和消极的元认知。较高水平的两种形式的无益元认知都会增强间接效应，而在积极元认知的第 50 百分位数以下或消极元认知的第 60 百分位数以下，这种间接效应并不显著。
强烈地认为思考疼痛有助于你解决问题或应对疼痛（积极的元认知），或者它是有害的和不可控的（消极的元认知），可能会随着疼痛的增加而增加你的担忧或沉思。这与增加的疼痛灾难化有关。识别和修改这些无益的疼痛元认知可能会改善疼痛灾难化的治疗，从而改善一般的慢性疼痛。
本研究表明，坚持性思维（担忧和沉思）介导了疼痛强度与灾难化之间的关系。与元认知理论一致，这种关联也受到对担忧和沉思的无益信念的调节。疼痛元认知可能成为新的治疗靶点，以帮助改善对疼痛相关痛苦的心理治疗，目前这些治疗方法的效果只是适度的。
