Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital.
Department of Psychiatry, Boston Children's Hospital and Harvard Medical School.
J Pediatr Psychol. 2021 Mar 18;46(3):351-362. doi: 10.1093/jpepsy/jsaa111.
Several factors are known to impact response to the intensive interdisciplinary pain treatment (IIPT) program described in this study, yet no research has explored the role of perfectionism. This secondary data analysis explored direct and indirect relations between perfectionism and functional disability (primary outcome) and pain severity (secondary outcome) after IIPT, with pain catastrophizing and fear of pain as mediators.
Youth (N = 253) aged 8-21 with chronic pain and associated disability completed pre- and post-IIPT measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), pain catastrophizing, fear of pain, functional disability, and pain characteristics for routine clinical care and this nonrandomized trial. Eight mediated models were run for the two predictors, two mediators, and two outcomes.
Pretreatment perfectionism (SOP and SPP) led to greater reductions in pain catastrophizing over the course of IIPT, which resulted in lower pain severity (β = -.02 [CI = -0.07, -0.01] for SOP and β = -.02 [CI = -0.06, -0.003] for SPP) and less functional disability (β = -.06 [CI = -0.13, -0.01] for SOP and β = -.06 [CI = -0.14, -0.01] for SPP). Independent of pain catastrophizing, pretreatment SPP was directly associated with more posttreatment functional disability (β = .16 [CI = 0.05, 0.27]). Fear of pain was not a mediator.
Findings suggest perfectionism has the potential to negatively impact IIPT outcomes. However, when perfectionistic youth with chronic pain learn to manage pain-related distress, they benefit. Results highlight the importance of assessing for and treating perfectionism and pain-related distress in youth with chronic pain.
已知有几个因素会影响到本文所述的强化跨学科疼痛治疗 (IIPT) 计划的反应，但没有研究探讨完美主义的作用。本二次数据分析探讨了完美主义与功能障碍（主要结果）和疼痛严重程度（次要结果）之间的直接和间接关系，疼痛灾难化和对疼痛的恐惧作为中介。
患有慢性疼痛和相关残疾的 8-21 岁青少年（N=253）在接受 IIPT 前后完成了自我导向完美主义（SOP）、社会规定完美主义（SPP）、疼痛灾难化、对疼痛的恐惧、功能障碍和疼痛特征的测量，用于常规临床护理和这项非随机试验。对两个预测因子、两个中介变量和两个结果运行了八个中介模型。
治疗前的完美主义（SOP 和 SPP）导致在 IIPT 过程中疼痛灾难化的减少更大，从而导致疼痛严重程度降低（SOP 的β=-.02 [CI=-0.07，-0.01]和 SPP 的β=-.02 [CI=-0.06，-0.003]）和功能障碍减少（SOP 的β=-.06 [CI=-0.13，-0.01]和 SPP 的β=-.06 [CI=-0.14，-0.01]）。独立于疼痛灾难化，治疗前的 SPP 与治疗后更多的功能障碍直接相关（β=0.16 [CI=0.05，0.27]）。恐惧不是中介。
研究结果表明，完美主义有可能对 IIPT 的结果产生负面影响。然而，当患有慢性疼痛的完美主义青年学会管理与疼痛相关的痛苦时，他们会受益。结果强调了在患有慢性疼痛的青少年中评估和治疗完美主义和与疼痛相关的痛苦的重要性。
