School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
PLoS One. 2024 May 13;19(5):e0301095. doi: 10.1371/journal.pone.0301095. eCollection 2024.
Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident.
The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population.
This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling.
Pain not only had a direct positive impact (B = 0.575; SE = 0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE = 0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE = 0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE = 0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data.
The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.
肌筋膜盆腔疼痛（MFPP）是一种常见的慢性盆腔疼痛，其特征是骨盆底肌肉触痛点。它可能导致身体和精神疲惫、生殖问题以及在日常生活和工作中应对困难，而不仅仅是疾病本身。疼痛相关的认知过程会影响疼痛缓解和生活质量。运动恐惧、自我效能感和疼痛灾难化通常被视为疼痛与其相关后果之间的中介因素。较高的运动恐惧和疼痛灾难化与不良的功能结果相关，而较高的自我效能感与生活质量的改善相关。对于生育年龄的女性 MFPP，运动恐惧、自我效能感和疼痛灾难化对日常干扰的影响是直接的还是间接的尚不清楚；因此，对每个变量的影响并不完全清楚。
本研究旨在通过运动恐惧、自我效能感和疼痛灾难化评估生育年龄女性 MFPP 的疼痛与日常干扰之间的关系，并根据该人群的数据确定未来研究和干预的方向。
这是一项多中心横断面研究。研究于 2022 年 11 月 15 日至 2023 年 11 月 10 日进行，从中国十个省的 14 家医院招募了 202 名生育年龄的 MFPP 女性患者。使用人口统计学变量、简明疼痛量表、坦帕运动恐惧量表、疼痛自我效能问卷和疼痛灾难化量表来测量参与者的相关信息。使用描述性分析、皮尔逊相关分析和序列中介模型对数据进行描述和分析。
疼痛不仅对日常干扰有直接的正向影响（B = 0.575；SE = 0.081；95%CI：LL = 0.415，UL = 0.735），而且通过疼痛灾难化的独立中介作用对日常干扰有间接影响（B = 0.088；SE = 0.028；95%CI：LL = 0.038，UL = 0.148），运动恐惧和灾难化的链式中介作用（B = 0.057；SE = 0.019；95%CI：LL = 0.024，UL = 0.098），以及运动恐惧、自我效能和灾难化的四阶段序列中介作用（B = 0.013；SE = 0.006；95%CI：LL = 0.003，UL = 0.027）。所提出的序列中介模型与收集的数据拟合良好。
研究结果表明，在生育年龄的 MFPP 女性患者的疼痛治疗中，解决疼痛灾难化和运动恐惧（特别是灾难化）以及提高自我效能感非常重要，并建议将功能恢复纳入疼痛治疗中。
