Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
Pain Med. 2021 May 21;22(5):1095-1108. doi: 10.1093/pm/pnaa370.
Despite decades of research on the identification of specific characteristics of situations that trigger a physiological stress response (novelty, unpredictability, threat to the ego, and sense of low control [NUTS]), no integrative research has examined the validity of this framework applied to pain experiences. This study aimed to 1) explore the stressful characteristics of pain among individuals living with chronic pain and 2) examine whether the NUTS framework comprehensively captures the stressful nature of pain.
Participants were 41 adult participants living with chronic pain.
Interviews in six focus groups were conducted in French using a semistructured interview guide. Participants first discussed how pain is stressful. Then, they were introduced to the NUTS framework and commented on the extent to which it captured their experience. The verbatim transcriptions of interviews were reviewed using reflexive thematic analysis. Analyses were conducted in French; quotes and themes were translated into English by a professional translator.
The pain-NUTS framework adequately captured participants' experiences. Multiple aspects of pain (pain intensity fluctuations, pain flare-up duration, pain quality and location, functional limitations, diagnosis and treatment) were associated with one or more stress-inducing characteristics. In addition, a second layer of meaning emerged in the context of chronic pain that provided contextual information regarding when, how, and why pain became more or less stressful.
The NUTS characteristics seem to offer a comprehensive framework to understand how pain and its context of chronicity can be a source of stress. This study provides preliminary support for the pain-NUTS framework to allow the formal integration of pain and stress research.
尽管数十年来一直在研究引发生理应激反应的特定情况特征（新颖性、不可预测性、对自我的威胁和低控制感[NUTS]），但尚无综合研究检验该框架应用于疼痛体验的有效性。本研究旨在：1）探讨慢性疼痛患者疼痛的应激特征；2）检验 NUTS 框架是否全面捕捉到疼痛的应激性质。
受试者为 41 名患有慢性疼痛的成年参与者。
使用半结构化访谈指南，以法语在六个焦点小组中进行访谈。参与者首先讨论了疼痛的应激特征。然后，向他们介绍了 NUTS 框架，并就其捕捉他们的体验的程度发表了评论。访谈的逐字记录使用反思性主题分析进行了审查。分析用法语进行；引用和主题由专业翻译翻译成英语。
疼痛-NUTS 框架充分捕捉到了参与者的体验。疼痛的多个方面（疼痛强度波动、疼痛发作持续时间、疼痛质量和位置、功能限制、诊断和治疗）与一个或多个应激诱发特征相关。此外，在慢性疼痛的背景下出现了第二层含义，提供了有关何时、如何以及为何疼痛变得更具或更不具压力的背景信息。
NUTS 特征似乎提供了一个全面的框架，以了解疼痛及其慢性背景如何成为压力的来源。本研究初步支持疼痛-NUTS 框架，以允许疼痛和应激研究的正式整合。
