Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pain Pract. 2020 Sep;20(7):714-723. doi: 10.1111/papr.12899. Epub 2020 May 11.
Trait mindfulness has been found to be inversely associated with emotional distress such as depression and anxiety among patients suffering from pain. The current study investigated the putative mechanisms underlying these associations by examining whether pain catastrophizing mediates the association between mindfulness and psychological distress and whether this model differs in patients suffering from chronic pain compared to patients experiencing nonchronic pain in a medical rehabilitation setting.
Forty-eight patients in their subacute stage of recovery participated in the study. Seventeen participants had a diagnosis of chronic pain. Trait mindfulness was assessed using the Mindful Attention Awareness Scale, pain catastrophizing was assessed using the Pain Catastrophizing Scale, depression symptoms were assessed using the Patient Health Questionnaire, and anxiety was assessed using the Generalized Anxiety Disorder scale. Two mediation models were used, with pain catastrophizing mediating the association between mindfulness and depression and anxiety.
Catastrophizing significantly mediated the association between trait mindfulness and depression (P < 0.05, confidence interval [CI] = -0.35, -0.05). Catastrophizing also mediated the relationship between trait mindfulness and anxiety (P < 0.05, CI = -0.34, -0.04). Two moderated mediation models were tested, in which pain catastrophizing fully mediated the relationship between trait mindfulness and depression and anxiety, but only in patients with chronic pain.
The negative association between trait mindfulness and psychological distress may thus be partly attributed to pain catastrophizing: individuals high in trait mindfulness engage in less catastrophic thinking and therefore experience less distress. Importantly, this was only observed in the patients with chronic pain. These results further underscore the need to cope with pain catastrophizing and encourage mindfulness among patients with chronic pain.
特质正念与疼痛患者的抑郁和焦虑等情绪困扰呈负相关。本研究通过考察疼痛灾难化是否在正念与心理困扰之间的关联中起中介作用，以及在医疗康复环境中经历慢性疼痛的患者与经历非慢性疼痛的患者相比，该模型是否存在差异，来研究这些关联的潜在机制。
48 名处于亚急性康复阶段的患者参与了这项研究。17 名参与者被诊断为慢性疼痛。特质正念使用正念注意觉察量表进行评估，疼痛灾难化使用疼痛灾难化量表进行评估，抑郁症状使用患者健康问卷进行评估，焦虑使用广泛性焦虑障碍量表进行评估。使用了两个中介模型，其中疼痛灾难化中介了正念与抑郁和焦虑之间的关联。
灾难化显著中介了特质正念与抑郁之间的关联（P<0.05，置信区间[CI] = -0.35，-0.05）。灾难化也中介了特质正念与焦虑之间的关系（P<0.05，CI = -0.34，-0.04）。测试了两个有调节的中介模型，其中疼痛灾难化完全中介了特质正念与抑郁和焦虑之间的关系，但仅在慢性疼痛患者中。
因此，特质正念与心理困扰之间的负相关可能部分归因于疼痛灾难化：特质正念水平高的个体较少进行灾难性思维，因此体验到的困扰也较少。重要的是，这仅在慢性疼痛患者中观察到。这些结果进一步强调了在慢性疼痛患者中应对疼痛灾难化和鼓励正念的必要性。
