Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
Pain Med. 2020 Feb 1;21(2):e89-e101. doi: 10.1093/pm/pnz211.
This study sets out to identify potential daily antecedents and consequences of pain-related activity avoidance and engagement behavior in adolescents with chronic pain.
Adolescents (N = 65, Mage = 14.41) completed baseline self-reports and a diary for 14 days. Afternoon and evening reports were used to infer a network structure of within-day associations between pain intensity, pain-related fear, pain catastrophizing, affect, and pain-related activity avoidance and engagement behavior. Baseline psychological flexibility was examined as a potential resilience factor.
Activity avoidance in the evening was predicted by pain-related fear and avoidance earlier that afternoon. Activity engagement was predicted by positive affect and activity engagement in the afternoon. Pain-related behavior in the afternoon was not related to subsequent changes in pain intensity, pain-related fear, pain catastrophizing, or affect. Pain-related fear in the afternoon was predictive of increased levels of pain and pain catastrophizing in the evening. Both pain-related fear and pain catastrophizing in the evening were predicted by negative affect in the afternoon. Psychological flexibility was associated with lower levels of daily activity avoidance and buffered the negative association between pain intensity and subsequent activity engagement.
This study provides insight into unique factors that trigger and maintain activity avoidance and engagement and into the role of psychological flexibility in pediatric pain. Future work should focus on both risk and resilience factors and examine the role of psychological flexibility in chronic pediatric pain in greater detail.
本研究旨在确定青少年慢性疼痛患者疼痛相关活动回避和参与行为的潜在日常前因和后果。
共纳入 65 名青少年（平均年龄 14.41 岁），他们完成了基线自我报告和 14 天的日记。使用午后和傍晚的报告推断出日间疼痛强度、疼痛相关恐惧、疼痛灾难化、情绪和疼痛相关活动回避和参与行为之间的网络结构。还检验了基线心理灵活性作为潜在的韧性因素。
傍晚的活动回避由当日午后的疼痛相关恐惧和回避所预测。下午的活动参与由积极情绪和下午的活动参与所预测。下午的疼痛相关行为与随后的疼痛强度、疼痛相关恐惧、疼痛灾难化或情绪变化无关。下午的疼痛相关恐惧可预测当晚疼痛和疼痛灾难化程度的增加。下午的疼痛相关恐惧和疼痛灾难化都可预测傍晚的消极情绪。心理灵活性与日常活动回避程度较低有关，并缓冲了疼痛强度与随后的活动参与之间的负相关关系。
本研究深入了解了引发和维持活动回避和参与的独特因素，以及心理灵活性在儿科疼痛中的作用。未来的研究应同时关注风险和韧性因素，并更详细地研究心理灵活性在慢性儿科疼痛中的作用。
