Division of Psychology, Faculty of Natural Sciences, University of Stirling.
Department of Anesthesiology and Pain Medicine, Faculty of Medicine & Dentistry, University of Alberta.
J Pediatr Psychol. 2021 Mar 18;46(3):286-292. doi: 10.1093/jpepsy/jsaa114.
To propose a new model outlining a hypothesized cyclical relation between executive functioning, emotional regulation, and chronic pain in adolescence and to highlight the likely importance of such a relation for self-management behavior and pain-related disability.
A review of the existing literature that critically explores the role of executive functioning in understanding chronic pain experiences and self-management in adolescence in order to develop the Cyclical model Of Pain, Executive function, emotion regulation, and Self-management (COPES).
Growing evidence points towards a potential cyclical relation between chronic pain and impaired executive functioning, which forms the basis of COPES. The COPES model proposes that the relative immaturity of executive functioning in adolescence negatively influences their ability to engage with self-management, which in turn increases adolescents' disability due to pain and contributes to the maintenance of chronic pain, which perpetuates the reduced capacity of executive functioning. The moderating influence of flexible parental support is hypothesized to offset some of these influences. However, the available evidence is limited due to methodological shortcomings such as large variety in executive functioning operationalization, reliance on self-report and cross-sectional designs.
It is anticipated that the COPES model will stimulate more systematic, theory-driven research to further our understanding of the links between executive functioning, chronic pain, self-management, and wellbeing. Such enhanced understanding has the potential to drive forward intervention development and refinement aimed at improving self-management uptake and adherence amongst adolescents with chronic pain.
提出一个新的模型，概述青少年执行功能、情绪调节和慢性疼痛之间假设的循环关系，并强调这种关系对自我管理行为和与疼痛相关的残疾的可能重要性。
对现有文献进行综述，批判性地探讨执行功能在理解青少年慢性疼痛体验和自我管理中的作用，以制定疼痛、执行功能、情绪调节和自我管理的循环模型（COPES）。
越来越多的证据表明慢性疼痛和执行功能受损之间可能存在循环关系，这是 COPES 的基础。COPES 模型提出，青少年执行功能相对不成熟会对他们参与自我管理的能力产生负面影响，这反过来又会因疼痛导致青少年残疾，并导致慢性疼痛的持续存在，从而进一步削弱执行功能。假设灵活的父母支持的调节作用可以抵消其中的一些影响。然而，由于方法学上的缺陷，如执行功能的操作化差异大、依赖自我报告和横断面设计，可用证据有限。
预计 COPES 模型将激发更系统、理论驱动的研究，以进一步了解执行功能、慢性疼痛、自我管理和幸福感之间的联系。这种更深入的理解有可能推动干预措施的发展和完善，旨在提高青少年慢性疼痛患者的自我管理参与度和依从性。
