Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Clinical Neurosciences, Neuropsychology, University of Helsinki and Neurocenter, Helsinki University Hospital, Helsinki, Finland.
Scand J Pain. 2020 Jul 28;20(3):545-553. doi: 10.1515/sjpain-2019-0137.
Background and aims Psychological resilience refers to successful adaptation or a positive outcome in the context of significant life adversity, such as chronic pain. On the other hand, anxiety closely associates with pain. The aim of this study was to explore how anxiety and psychological resilience together associate with persistent and experimental pain. Methods In a cross-sectional design, we studied 160 patients who had previously been treated for breast cancer and who now reported at least moderate pain (NRS ≥ 4) in any area of the body. Psychological resilience was measured on the Resilience Scale-14, anxiety on the Hospital Anxiety and Depression Scale, and intensity and interference of persistent pain by means of the Brief Pain Inventory. The cold pressor test was conducted to assess sensitivity to experimental cold pain. Results The results showed that resilience associated with pain interference in persistent pain, and that anxiety moderated this effect. Higher psychological resilience was associated with lower pain interference and this association was stronger in patients with low anxiety than among patients with high anxiety. These effects were visible with regard to persistent pain but not in experimental cold pain. Conclusions These results indicate that chronic pain and experimental pain as well as pain severity and pain interference are psychologically different phenomena. Psychological resilience protects against pain interference but effectively only in patients with low anxiety. It is necessary also to consider protective factors in addition to vulnerability factors in cases of persistent pain. Implications Resilience has been considered a potential target for intervention in chronic pain. However, high levels of anxiety might diminish the protective effect of psychological resilience in clinical settings. Therefore, it is important to treat anxiety in addition to resilience enhancing interventions. Patients with low psychological distress might be more suitable for resilience enhancing interventions than patients with high anxiety.
背景与目的 心理弹性是指在重大生活逆境（如慢性疼痛）背景下成功适应或取得积极结果。另一方面，焦虑与疼痛密切相关。本研究旨在探讨焦虑和心理弹性如何共同与持续性和实验性疼痛相关。
方法 在横断面设计中，我们研究了 160 名曾接受过乳腺癌治疗且目前报告身体任何部位至少中度疼痛（NRS≥4）的患者。使用韧性量表-14 测量心理韧性，使用医院焦虑和抑郁量表测量焦虑，使用简明疼痛量表评估持续性疼痛的强度和干扰。通过冷加压试验评估对实验性冷痛的敏感性。
结果 结果表明，韧性与持续性疼痛的疼痛干扰有关，焦虑调节了这种效应。较高的心理韧性与较低的疼痛干扰相关，这种相关性在焦虑程度较低的患者中比在焦虑程度较高的患者中更强。这些效应在持续性疼痛中可见，但在实验性冷痛中不可见。
结论 这些结果表明，慢性疼痛和实验性疼痛以及疼痛严重程度和疼痛干扰是心理上不同的现象。心理韧性可以预防疼痛干扰，但在焦虑程度较低的患者中效果更为显著。在持续性疼痛的情况下，除了易感性因素外，还需要考虑保护因素。
意义 心理弹性已被认为是慢性疼痛干预的潜在目标。然而，高水平的焦虑可能会降低心理弹性在临床环境中的保护作用。因此，除了增强韧性的干预措施外，还需要治疗焦虑。与焦虑程度较高的患者相比，心理困扰程度较低的患者可能更适合进行增强韧性的干预措施。
