Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States.
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, United States.
Pain Med. 2024 Jan 4;25(1):63-70. doi: 10.1093/pm/pnad119.
Orthopedic patients report pain as their main symptom complaint. Subjective pain experience is correlated with self-reported psychological state, such as distress.
This study tests whether scores from a measure of mindful attention are associated with subjective pain levels and whether psychological distress scores function as a mediation path.
During routine visits to a single orthopedic clinic in East Los Angeles, California, 525 patients were recruited to participate in the study. Participants reported on measures of pain (Universal Pain Assessment Tool [UPAT]), mindful attention (Five-Facet Mindfulness Questionnaire [FFMQ]), and psychological distress (Depression, Anxiety, Stress Scale [DASS]). We used Pearson correlations to examine relationships between FFMQ and UPAT scores and mediation analyses to test indirect effects of DASS scores as a mediation path.
The average age of the sample was 54 years (range 18-98 years), 61% were male, and 64% were non-Hispanic White individuals. The locations of injury were the shoulder (72%), elbow (21%), and clavicle or wrist (7%). Ninety-one percent reported mild or greater pain in the prior 2 weeks (mean = 4.2 ± 2.5, range 0-10), and 49% reported mild or more severe distress symptoms (DASS: 13.0 ± 11.5). FFMQ scores inversely predicted UPAT scores (β = -0.22, P < .01), mediated through DASS scores. DASS subscale scores for depression (β = -0.10, P = .02) and stress (β = -0.08, P = .04) but not anxiety (β = -0.03, P = .33) produced significant indirect effects. FFMQ acting-with-awareness and non-judging subscales had the largest effect on depression and stress DASS subscale scores.
We find statistical support to suggest that distress-particularly depressed mood and stress-mediates the association between mindful attention and pain intensity among orthopedic patients. A disposition of mindful attention might counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.
骨科患者报告疼痛是他们的主要症状。主观疼痛体验与自我报告的心理状态相关，如痛苦。
本研究测试正念注意量表的评分是否与主观疼痛水平相关，以及心理困扰评分是否作为中介途径。
在加利福尼亚州东洛杉矶的一家骨科诊所的常规就诊期间，招募了 525 名患者参与研究。参与者报告了疼痛（通用疼痛评估工具 [UPAT]）、正念注意（五因素正念量表 [FFMQ]）和心理困扰（抑郁、焦虑、压力量表 [DASS]）的情况。我们使用皮尔逊相关分析来检查 FFMQ 和 UPAT 评分之间的关系，并使用中介分析来测试 DASS 评分作为中介途径的间接效应。
样本的平均年龄为 54 岁（18-98 岁），61%为男性，64%为非西班牙裔白人。受伤部位为肩部（72%）、肘部（21%）和锁骨或手腕（7%）。91%的人报告在前两周有轻度或更严重的疼痛（平均=4.2±2.5，范围 0-10），49%的人报告有轻度或更严重的困扰症状（DASS：13.0±11.5）。FFMQ 评分与 UPAT 评分呈负相关（β=-0.22，P<.01），通过 DASS 评分介导。抑郁（β=-0.10，P=.02）和压力（β=-0.08，P=.04）的 DASS 分量表得分，但不是焦虑（β=-0.03，P=.33）的 DASS 分量表得分产生了显著的间接效应。FFMQ 的行动觉察和非评判分量表对抑郁和压力 DASS 分量表得分的影响最大。
我们发现有统计学证据表明，困扰——尤其是抑郁情绪和压力——在骨科患者的正念注意与疼痛强度之间起中介作用。正念注意的倾向可能会对抗加剧主观疼痛的困扰疾病，这对向骨科患者提供正念训练干预可能具有重要意义。
