Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA.
Department of Physical Medicine and Rehabilitation, University of California, Los Angeles, USA.
NeuroRehabilitation. 2020;47(1):35-43. doi: 10.3233/NRE-203084.
Chronic musculoskeletal pain is a complex problem, particularly for individuals with head injury and comorbid psychiatric conditions. The Fear Avoidance Model offers one of the strongest opportunities to conceptualize comorbid traumatic injury and pain, but this model is largely untested.
This study tests the Fear Avoidance Model of chronic pain using a sample from a study of polytrauma patients in a large Department of Veterans Affairs facility who participated in a federally-funded study of interdisciplinary chronic pain management.
The present study comprises a secondary analysis of 93 veterans with chronic pain, head injury, posttraumatic stress symptoms and a history of persistent opioid use. Standardized measures of Fear Avoidance Model risk factors (e.g., pain catastrophizing, fear avoidance beliefs, anxiety, depression) were examined as cross-sectional predictors of pain-related disability.
Secondary data analysis revealed that Fear Avoidance Model factors accounted for almost 40% of the variance in pain-related disability, with pain catastrophizing and depression demonstrating the strongest relationships with disability. A summary variable combining all four factors revealed a 6% increase in disability for each factor that was clinically significant for the sample patients.
This study represents the first attempt to examine a complex, theoretical model of pain in a comorbid pain and TBI sample. Findings revealed a strong relationship between this model and pain-related disability that outperforms pain intensity ratings. This model could be used to guide better treatment for comorbid pain and TBI.
慢性肌肉骨骼疼痛是一个复杂的问题，特别是对于头部受伤和合并精神疾病的个体。恐惧回避模型为理解合并创伤性损伤和疼痛提供了最强的机会之一，但该模型在很大程度上尚未得到验证。
本研究使用来自退伍军人事务部大型设施中多发性创伤患者研究的样本，对慢性疼痛的恐惧回避模型进行测试，这些患者参与了联邦资助的跨学科慢性疼痛管理研究。
本研究包括对 93 名慢性疼痛、头部受伤、创伤后应激症状和持续使用阿片类药物史的退伍军人进行的二次分析。将恐惧回避模型风险因素（例如，疼痛灾难化、恐惧回避信念、焦虑、抑郁）的标准化测量作为疼痛相关残疾的横断面预测因素进行检查。
二次数据分析显示，恐惧回避模型因素解释了疼痛相关残疾变异的近 40%，疼痛灾难化和抑郁与残疾的关系最强。将四个因素结合起来的综合变量显示，每个因素的残疾增加了 6%，对于样本患者来说，这一增加具有临床意义。
本研究首次尝试在合并疼痛和 TBI 的样本中检查疼痛的复杂理论模型。研究结果表明，该模型与疼痛相关残疾之间存在很强的关系，其表现优于疼痛强度评分。该模型可用于指导合并疼痛和 TBI 的更好治疗。
