Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland.
ZHAW Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland.
Eur J Pain. 2022 Aug;26(7):1569-1580. doi: 10.1002/ejp.1983. Epub 2022 Jun 11.
Quantitative data on longitudinal associations between catastrophizing and pain or physical function are patchy. The study aimed to quantify the prognostic value of catastrophizing for pain and function in fibromyalgia and low back pain before and after rehabilitation.
The associations of state and change on the Multidimensional Pain Inventory (MPI) Pain severity scale, the Short Form 36 (SF-36) Physical functioning scale and the Six-Minute Walking Distance (6MWD) with the Coping Strategies Questionnaire (CSQ) Catastrophizing scale were quantified by multiple regression modelling to adjust for confounders.
Sex- and age-matched cohorts (n = 71 each) were compared. Pain and catastrophizing were worse in fibromyalgia than in low back pain, whereas the function levels were comparable. Baseline catastrophizing predicted pain change by adjusted correlations of 0.552 (fibromyalgia) and 0.450 (low back pain), self-rated function by 0.403 and 0.308, and the 6MWD by 0.270 and - 0.072. The change in catastrophizing was associated to the change in pain by 0.440 (fibromyalgia) and 0.614 (low back pain), self-rated function by 0.122 and 0.465, and the 6MWD by 0186 and 0.162.
Catastrophizing (pain-related worrying) was a potential prognostic factor, especially for pain and somewhat less for self-rated physical function but it was only weakly predictive for the walking distance in both conditions, independently of potential confounders, such as sex, age, baseline severity and others. Reduction of maladaptive coping should be integrated into the management of chronic pain.
Our study showed surprisingly high associations between state and change in catastrophizing to pain relief and functional improvement in chronic pain patients. This is supported by clinical experience and research data, even if the construct and measurement of catastrophizing is under debate. Our findings and those of literature point to more pessimistic self-rating of pain and catastrophizing in fibromyalgia when compared to other conditions. This might obscure positive effects on pain and function achieved by adaptive coping in fibromyalgia.
关于灾难性思维与疼痛或身体功能之间纵向关联的定量数据参差不齐。本研究旨在量化康复前后纤维肌痛和腰痛患者灾难性思维对疼痛和功能的预后价值。
通过多元回归模型，量化多维疼痛量表（MPI）疼痛严重程度量表、36 项简短健康调查量表（SF-36）身体功能量表和 6 分钟步行距离（6MWD）与应对策略问卷（CSQ）灾难化量表的状态和变化之间的关联，并进行调整以控制混杂因素。
对性别和年龄匹配的队列（每组 71 例）进行了比较。纤维肌痛患者的疼痛和灾难化程度高于腰痛患者，而功能水平相当。基线灾难化预测疼痛变化的校正相关系数分别为 0.552（纤维肌痛）和 0.450（腰痛），自我评定功能为 0.403 和 0.308，6MWD 为 0.270 和-0.072。灾难化的变化与疼痛的变化相关，校正相关系数分别为 0.440（纤维肌痛）和 0.614（腰痛），自我评定功能为 0.122 和 0.465，6MWD 为 0.186 和 0.162。
灾难性思维（与疼痛相关的担忧）是一个潜在的预后因素，特别是对疼痛，对自我评定的身体功能影响较小，但它在两种情况下仅对步行距离有较弱的预测作用，独立于潜在的混杂因素，如性别、年龄、基线严重程度等。减少不良应对方式应纳入慢性疼痛的管理中。
我们的研究显示，在慢性疼痛患者中，灾难性思维的状态和变化与疼痛缓解和功能改善之间存在惊人的高关联。这得到了临床经验和研究数据的支持，即使灾难性思维的构建和测量存在争议。我们的研究结果和文献研究结果表明，与其他疾病相比，纤维肌痛患者对疼痛和灾难性思维的自我评估更为悲观。这可能会掩盖纤维肌痛患者通过适应性应对所取得的对疼痛和功能的积极影响。
