Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
J Pain. 2024 Jul;25(7):104483. doi: 10.1016/j.jpain.2024.01.348. Epub 2024 Jan 29.
Although evidence supports the importance of pain-related thoughts (ie, cognitive content, or what people think) as predictors of pain and pain-related function, evidence regarding the role of cognitive processes (ie, how people think about pain, eg, by accepting pain, not making judgments about pain, or being absorbed by the pain experience) in adjustment to chronic pain is in its early stages. Using baseline data from a clinical trial of individuals with chronic low back pain (N = 327), the study aimed to increase knowledge regarding the associations between cognitive processes, pain intensity, pain interference, and depression. The results indicate that a number of cognitive processes are significantly related to pain intensity when controlling for catastrophizing, although the pattern of associations found was opposite to those anticipated. One cognitive process (pain absorption) was found to be significantly associated with pain interference, and 9 of 10 cognitive processes were significantly associated with depression when controlling for catastrophizing. In each case, the processes thought to be adaptive were negatively associated with pain interference and depression, and processes thought to be maladaptive evidenced the opposite pattern. The findings are consistent with-but do not prove, given the cross-sectional nature of the data-the possibility that cognitive processes play an important role in adjustment to chronic pain. The potential role these variables play in depression was particularly noteworthy. Longitudinal and experimental studies to evaluate the causal nature of the associations identified are warranted. PERSPECTIVE: The study findings highlight the potential importance of cognitive process variables (ie, how people think) in adjustment to chronic pain. Research to evaluate cognitive processes as potential mechanism variables in pain treatment is warranted.
虽然有证据表明与疼痛相关的思维（即认知内容或人们的想法）作为疼痛和与疼痛相关的功能的预测因素很重要，但关于认知过程（即人们如何思考疼痛，例如，接受疼痛、不对疼痛做出判断或沉浸在疼痛体验中）在慢性疼痛适应中的作用的证据还处于早期阶段。本研究使用慢性下背痛患者临床试验的基线数据（N=327），旨在增加对认知过程、疼痛强度、疼痛干扰和抑郁之间关联的了解。结果表明，在控制灾难化的情况下，许多认知过程与疼痛强度显著相关，尽管发现的关联模式与预期相反。一个认知过程（疼痛吸收）与疼痛干扰显著相关，而在控制灾难化的情况下，有 10 个认知过程中的 9 个与抑郁显著相关。在每种情况下，被认为是适应性的过程与疼痛干扰和抑郁呈负相关，而被认为是适应性的过程则表现出相反的模式。这些发现与数据的横断面性质一致，但不能证明认知过程在慢性疼痛适应中起着重要作用。这些变量在抑郁中的潜在作用尤其值得注意。需要进行纵向和实验研究来评估所确定关联的因果性质。观点：研究结果强调了认知过程变量（即人们的思维方式）在慢性疼痛适应中的潜在重要性。有必要进行研究以评估认知过程作为疼痛治疗中潜在的机制变量。
