Schools of Health Science.
Department of Exercise Sciences, University of Auckland, Auckland, NSW, New Zealand.
Clin J Pain. 2021 Dec 1;37(12):872-880. doi: 10.1097/AJP.0000000000000991.
The fear-avoidance model (FAM) is used to explain pain-related disability and design targeted interventions for people with chronic low back pain. While treatment engagement is critical, it is unknown how treatment moderates the FAM.
This study examined whether pathways within the FAM were moderated by treatment engagement in 508 people with chronic low back pain. Measures of disability, pain, fear, catastrophizing, anxiety, depression, and self-efficacy were collected through self-report, and descriptors of treatment engaged within the last month (physical activity type, medication, allied and medical health practitioner). Moderated mediation analyses were performed to examine the conditional effect of treatment engagement on fear-avoidance pathways.
The conditional effect of anxiety on disability was only significant for people who did not report any treatment engagement in the last month (B=1.03, 95% confidence interval: 0.53-1.53, P<0.001). The effect of depression increased for people reporting more different types of treatment in the last month (1 level of treatment increase, B=0.27, 95% confidence interval: 0.05-0.50, P=0.019). Conversely, greater treatment engagement had a positive influence on the mediating effect of self-efficacy. That is, the effect of pain on efficacy reduced with greater treatment engagement, with a concomitant increased effect of self-efficacy on disability.
Clinicians should explore the history and rationale behind patient treatment seeking behavior to ensure this is not reinforcing the negative effects of depressive symptoms on pain-related disability.
恐惧回避模型（FAM）用于解释与疼痛相关的残疾，并为慢性下背痛患者设计针对性的干预措施。虽然治疗参与至关重要，但尚不清楚治疗如何调节 FAM。
本研究在 508 名慢性下背痛患者中，考察了治疗参与是否调节了 FAM 中的途径。通过自我报告收集残疾、疼痛、恐惧、灾难化、焦虑、抑郁和自我效能感的测量，以及过去一个月内治疗参与的描述（体育活动类型、药物、辅助和医疗保健从业者）。进行了调节中介分析，以检验治疗参与对恐惧回避途径的条件效应。
仅在过去一个月内未报告任何治疗参与的人群中，焦虑对残疾的条件效应才具有统计学意义（B=1.03，95%置信区间：0.53-1.53，P<0.001）。对于报告过去一个月内接受更多不同类型治疗的人群，抑郁的影响增加（治疗增加 1 个水平，B=0.27，95%置信区间：0.05-0.50，P=0.019）。相反，更多的治疗参与对自我效能的中介效应有积极影响。也就是说，疼痛对效能的影响随着治疗参与的增加而降低，而自我效能对残疾的影响则增加。
临床医生应探讨患者寻求治疗的历史和理由，以确保这不会强化抑郁症状对疼痛相关残疾的负面影响。
