Neurology Department, Oregon Health and Science University, Portland, Oregon, USA.
School of Graduate Psychology, Pacific University, Forest Grove, Oregon, USA.
Pain Pract. 2022 Feb;22(2):222-232. doi: 10.1111/papr.13083. Epub 2021 Nov 11.
BACKGROUND: Central sensitization (CS), defined as the amplification of neural signaling within the CNS that elicits pain hypersensitivity, is thought be a characteristic of several chronic pain conditions. Maladaptive body awareness is thought to contribute and maintain CS. Less is known about the relationship between CS and adaptive body awareness. PURPOSE: This cross-sectional study investigated relationships among self-reported adaptive body awareness (Multidimensional Interoceptive Awareness Scale-2; MAIA-2), CS-related symptoms (Central Sensitization Inventory; CSI), and pain intensity and further delineate potential direct and indirect links among these constructs. METHODS: Online surveys were administered to 280 individuals with chronic pain reporting elevated CSI scores. Strategic sampling targeted respondents to reflect the 2010 census. Pearson's correlations characterized overall relationship between variables. Multiple regression analyses investigated potential direct links. A path analysis assessed mediational effects of CS-related symptoms on the relationship between adaptive body awareness and pain intensity. RESULTS: CSI demonstrated strong, inverse correlations with some MAIA-2 subscales, but positive correlations with others. Higher CSI scores predicted greater pain intensity (b = 0.049, p ≤ 0.001). Two MAIA-2 subscales, Not-Distracting (b = -0.56, p ≤ 0.001) and Not-Worrying (b = -1.17, p ≤ 0.001) were unique predictors of lower CSI. Not-Distracting (b = -0.05, p = 0.003) and Not-Worrying (b = -0.06, p = 0.007) uniquely predicted lower pain intensity. CSI completely mediated the relationship between adaptive body awareness and pain intensity [point estimate = -0.04; 95% bootstrap confident intervals (CI) = -0.05 to -0.02]. CONCLUSIONS: Findings also support future research to explore causal relationships of variables. Findings suggest that frequency of attention to bodily sensations is distinct from cognitive-affective appraisal of bodily sensation, and the two distinct higher order processes may have divergent influences on perceived pain and CS-related symptoms. Results also support future research to explore causal relationships of variables.
背景：中枢敏化（CS）被定义为中枢神经系统内神经信号的放大，导致痛觉过敏，被认为是几种慢性疼痛状况的特征。适应性身体意识被认为有助于并维持 CS。关于 CS 与适应性身体意识之间的关系知之甚少。
目的：本横断面研究调查了自我报告的适应性身体意识（多维内感受意识量表-2；MAIA-2）、与 CS 相关的症状（中枢敏化量表；CSI）以及疼痛强度之间的关系，并进一步描述这些结构之间潜在的直接和间接联系。
方法：向 280 名报告 CSI 评分升高的慢性疼痛患者在线调查。战略抽样的目标是反映 2010 年的人口普查。皮尔逊相关分析描述了变量之间的总体关系。多元回归分析调查了潜在的直接联系。路径分析评估了 CS 相关症状对适应性身体意识与疼痛强度之间关系的中介效应。
结果：CSI 与 MAIA-2 的一些分量表呈强烈的负相关，但与其他分量表呈正相关。较高的 CSI 评分预测疼痛强度更高（b=0.049，p≤0.001）。MAIA-2 的两个分量表，不分散注意力（b=-0.56，p≤0.001）和不担心（b=-1.17，p≤0.001）是 CSI 较低的独特预测因素。不分散注意力（b=-0.05，p=0.003）和不担心（b=-0.06，p=0.007）独特地预测疼痛强度较低。CSI 完全介导了适应性身体意识和疼痛强度之间的关系[点估计值=-0.04；95% 自举置信区间（CI）=-0.05 至-0.02]。
结论：研究结果还支持进一步研究探索变量的因果关系。研究结果表明，对身体感觉的注意力频率与对身体感觉的认知-情感评估不同，这两个不同的高阶过程可能对感知疼痛和与 CS 相关的症状有不同的影响。研究结果还支持进一步研究探索变量的因果关系。
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