Department of Neurosurgery and Spine Surgery, University Medicine Essen, University of Duisburg-Essen, Germany.
Clinical Neuropsychology, Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.
Exp Clin Endocrinol Diabetes. 2022 Oct;130(10):693-700. doi: 10.1055/a-1851-5017. Epub 2022 Aug 17.
Headache in patients with tumors of the sellar region (TSR) has previously been attributed entirely to biomechanical causes. This study aimed to investigate the influence of psychological determinants for the occurrence of and disability due to headaches in patients with TSR.
This was a cross-sectional single-center study with a logistic regression approach. Eighty-four patients (75%) with pituitary adenomas and 28 with other TSR prior to first-time neurosurgery were investigated. One-hundred and twelve patients received standardized questionnaires on personality, headache characteristics, and disability due to headache. Fifty-nine patients additionally filled in questionnaires about coping with stress and pain catastrophizing. Separate logistic regression models were used to predict the risk of headache occurrence and disability due to headache by personality, stress coping, and pain catastrophizing.
Conscientiousness, neuroticism, and pain catastrophizing were significant predictors of headache occurrence. The amount of explained variance for both models predicting headache occurrence was comparable to that in primary headache. Neuroticism, pain catastrophizing, and humor as a coping strategy predicted disability due to headache with a high variance explanation of 20-40%.
For the first time, we report data supporting a strong psychological influence on headache and headache-related disability in patients with TSR, which argue against purely mechanistic explanatory models. Physicians treating patients with TSR and headaches should adopt an integrative diagnostic and treatment approach, taking the biopsychosocial model of pain into account.
先前，鞍区肿瘤（TSR）患者的头痛被完全归因于生物力学原因。本研究旨在探讨心理决定因素对 TSR 患者头痛发生和头痛致残的影响。
这是一项横断面单中心研究，采用逻辑回归方法。在首次神经外科手术前，对 84 例垂体腺瘤患者（75%）和 28 例其他 TSR 患者进行了调查。112 例患者接受了人格、头痛特征和头痛致残问卷的标准化调查。59 例患者另外填写了关于应对压力和疼痛灾难化的问卷。分别使用逻辑回归模型，通过人格、压力应对和疼痛灾难化来预测头痛发生和头痛致残的风险。
尽责性、神经质和疼痛灾难化是头痛发生的显著预测因素。两个预测头痛发生模型的解释方差量与原发性头痛相当。神经质、疼痛灾难化和幽默作为应对策略可以预测头痛致残，解释方差为 20%-40%。
我们首次报告的数据支持 TSR 患者的头痛和与头痛相关的残疾受强烈心理影响，这与纯粹的机械解释模型相悖。治疗 TSR 和头痛患者的医生应采用综合诊断和治疗方法，考虑疼痛的生物心理社会模型。
