Demjen Stefan, Bakal Donald
Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4 Canada.
Pain. 1986 May;25(2):187-194. doi: 10.1016/0304-3959(86)90092-8.
This study examined the nature of the cognitions experienced by chronic headache sufferers during headache episodes and assessed whether these cognitions were differentially related to illness behavior and to symptom properties of headache attacks. The data were examined both in terms of headache severity and in terms of the muscle contraction-migraine dichotomy. Forty-four headache patients monitored, with an open-ended assessment format, the thoughts and feelings experienced prior to and during episodes of head pain. The majority of patient responses could reliably be placed into 1 of 2 categories: (a) stress-related cognitions and (b) disorder-related cognitions. The percentage of headache-related thoughts and feelings correlated significantly with several indices of headache severity, including intensity of pain, quality of pain, length of headache attacks, and presence of early morning onset. Further significance to these findings was added by demonstrating that the patients who predominantly reported disorder-related cognitions also displayed a tendency to deny life problems not related to pain. The data were taken as support for the hypothesis that chronic headache disorders of increased severity are accompanied by a cognitive shift whereby the patient's primary concern moves from situational and interpersonal stress to distress associated with the disorder itself.
本研究考察了慢性头痛患者在头痛发作期间所经历认知的本质，并评估了这些认知与疾病行为以及头痛发作的症状特征之间是否存在差异关联。数据从头痛严重程度以及肌肉收缩性头痛 - 偏头痛二分法两个方面进行了分析。44名头痛患者采用开放式评估形式，监测了头痛发作前及发作期间所经历的想法和感受。大多数患者的反应能够可靠地归为两类之一：（a）与压力相关的认知，以及（b）与疾病相关的认知。与头痛相关的想法和感受的百分比与头痛严重程度的几个指标显著相关，包括疼痛强度、疼痛性质、头痛发作时长以及清晨发作情况。通过证明主要报告与疾病相关认知的患者也表现出否认与疼痛无关的生活问题的倾向，进一步凸显了这些发现的重要性。这些数据支持了以下假设：严重程度增加的慢性头痛疾病伴随着一种认知转变，即患者的主要关注点从情境和人际压力转移到与疾病本身相关的痛苦。
