Waardenburg Sophie, Visseren Lars, van Daal Elke, Brouwer Brigitte, van Zundert Jan, van Kuijk Sander M J, Lousberg Richel, Jongen Ellen M M, Leue Carsten, de Meij Nelleke
Department of Anesthesiology and Pain Management, Maastricht University Medical Centre MUMC+, 6229 HX Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre MUMC+, 6229 HX Maastricht, The Netherlands.
J Clin Med. 2022 Sep 20;11(19):5515. doi: 10.3390/jcm11195515.
Fear-avoidance is one of the factors associated with chronic pain. However, it remains unclear whether the association between fear-avoidance and pain depends on sex. The present study aimed to investigate whether the association between fear-avoidance and pain intensity differed between men and women in chronic pain patients. Additionally, the potential confounding effect of affective experiences on the association between fear-avoidance and pain intensity was analyzed.
This cohort study included hospital referred chronic pain patients ( = 45). Short momentary assessment questions according to the experience sampling method (ESM) were used to repeatedly assess patients' pain intensity, level of fear-avoidance and positive as well as negative affect during their daily life. Linear mixed-effects models were applied in the statistical analysis. Unadjusted and adjusted models were made, in which the latter corrected for statistically significant affective experiences and baseline variables, taking the Aikake Information Criterion into account to assess a better model of fit.
The results demonstrated an association between fear-avoidance and pain intensity that differed for men and women. In men ( = 13), no association between these variables was found (-0.04 (95% CI: -0.14, 0.06) with a -value of 0.48), whereas in women ( = 32), an increase in fear-avoidance was associated with a (slight) increase in pain intensity (0.18 (95% CI 0.06, 0.30) with a -value of 0.003). Affect did not confound the above-mentioned findings.
Our data supports previous research highlighting the importance of sex differences in pain experience. These findings may be relevant for clinicians to consider more personalized (i.e., gender specific) pain management in chronic pain patients.
恐惧回避是与慢性疼痛相关的因素之一。然而，恐惧回避与疼痛之间的关联是否取决于性别仍不清楚。本研究旨在调查慢性疼痛患者中，恐惧回避与疼痛强度之间的关联在男性和女性中是否存在差异。此外，还分析了情感体验对恐惧回避与疼痛强度之间关联的潜在混杂效应。
这项队列研究纳入了医院转诊的慢性疼痛患者（n = 45）。采用基于经验取样法（ESM）的简短即时评估问题，在患者日常生活中反复评估其疼痛强度、恐惧回避水平以及积极和消极情绪。统计分析采用线性混合效应模型。构建了未调整模型和调整模型，后者对具有统计学意义的情感体验和基线变量进行了校正，并考虑了赤池信息准则以评估更好的拟合模型。
结果表明，恐惧回避与疼痛强度之间的关联在男性和女性中存在差异。在男性（n = 13）中，未发现这些变量之间存在关联（β = -0.04，95%CI：-0.14, 0.06，p值 = 0.48），而在女性（n = 32）中，恐惧回避的增加与疼痛强度的（轻微）增加相关（β = 0.18，95%CI 0.06, 0.30，p值 = 0.003）。情感并未混淆上述结果。
我们的数据支持了先前强调疼痛体验中性别差异重要性的研究。这些发现可能对临床医生在慢性疼痛患者中考虑更个性化（即针对特定性别的）疼痛管理具有参考价值。
