Department I-Psychology, University of Trier, Trier, Germany.
Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
PLoS One. 2021 Mar 25;16(3):e0248875. doi: 10.1371/journal.pone.0248875. eCollection 2021.
Identifying pain-related response patterns and understanding functional mechanisms of symptom formation and recovery are important for improving treatment.
We aimed to replicate pain-related avoidance-endurance response patterns associated with the Fear-Avoidance Model, and its extension, the Avoidance-Endurance Model, and examined their differences in secondary measures of stress, action control (i.e., dispositional action vs. state orientation), coping, and health.
Latent profile analysis (LPA) was conducted on self-report data from 536 patients with chronic non-specific low back pain at the beginning of an inpatient rehabilitation program. Measures of stress (i.e., pain, life stress) and action control were analyzed as covariates regarding their influence on the formation of different pain response profiles. Measures of coping and health were examined as dependent variables.
Partially in line with our assumptions, we found three pain response profiles of distress-avoidance, eustress-endurance, and low-endurance responses that are depending on the level of perceived stress and action control. Distress-avoidance responders emerged as the most burdened, dysfunctional patient group concerning measures of stress, action control, maladaptive coping, and health. Eustress-endurance responders showed one of the highest levels of action versus state orientation, as well as the highest levels of adaptive coping and physical activity. Low-endurance responders reported lower levels of stress as well as equal levels of action versus state orientation, maladaptive coping, and health compared to eustress-endurance responders; however, equally low levels of adaptive coping and physical activity compared to distress-avoidance responders.
Apart from the partially supported assumptions of the Fear-Avoidance and Avoidance-Endurance Model, perceived stress and dispositional action versus state orientation may play a crucial role in the formation of pain-related avoidance-endurance response patterns that vary in degree of adaptiveness. Results suggest tailoring interventions based on behavioral and functional analysis of pain responses in order to more effectively improve patients quality of life.
识别与疼痛相关的反应模式，了解症状形成和恢复的功能机制，对于改善治疗至关重要。
我们旨在复制与恐惧回避模型相关的疼痛相关回避-耐受反应模式及其扩展，即回避-耐受模型，并检查其在压力、行动控制（即性格行动与状态取向）、应对和健康的次要测量指标中的差异。
对 536 名慢性非特异性下腰痛患者在住院康复计划开始时的自我报告数据进行潜在剖面分析（LPA）。压力（即疼痛、生活压力）和行动控制的测量值被分析为影响不同疼痛反应模式形成的协变量。应对和健康的测量值被作为因变量进行检查。
部分符合我们的假设，我们发现了三种疼痛反应模式，即痛苦回避、良性压力耐受和低耐受力反应，这取决于感知压力和行动控制的水平。痛苦回避反应者作为最受困扰、功能失调的患者群体，在压力、行动控制、适应不良应对和健康方面的测量指标上表现突出。良性压力耐受反应者表现出最高的性格行动与状态取向水平之一，以及最高的适应性应对和身体活动水平。低耐受力反应者报告的压力水平较低，性格行动与状态取向、适应不良应对和健康水平与良性压力耐受反应者相当；然而，与痛苦回避反应者相比，适应性应对和身体活动水平同样较低。
除了恐惧回避和回避-耐受模型的部分假设得到支持外，感知压力和性格行动与状态取向可能在疼痛相关回避-耐受反应模式的形成中起着关键作用，这些模式在适应度上有所不同。结果表明，根据疼痛反应的行为和功能分析，为患者量身定制干预措施，可能更有效地提高患者的生活质量。
