Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy.
Stress Health. 2024 Oct;40(5):e3436. doi: 10.1002/smi.3436. Epub 2024 Jun 19.
Chronic pain, with its complex and multidimensional nature, poses significant challenges in identifying effective long-term treatments. There is growing scientific interest in how psychopathological and personality dimensions may influence the maintenance and development of chronic pain. This longitudinal study aimed to investigate whether alexithymia can predict the improvement of pain severity following a treatment-as-usual programme for chronic musculoskeletal pain over and above psychological cofactors (emotional distress, catastrophizing, and self-efficacy). A consecutive sample of 129 patients with diagnosed chronic musculoskeletal pain referred to two tertiary care centres was recruited and treated for 16 weeks. Clinical pain, psychological distress, self-efficacy, catastrophizing, and alexithymia were assessed with validated self-report measures at the first medical visit (T0) and at 16-week follow-up (T1). Compared with non-responder patients (n = 72, 55.8%), those who responded (i.e., reduction of >30% in pain severity; n = 57, 44.2%) reported an overall improvement in psychological variables except alexithymia. Alexithymia showed relative stability between baseline and follow-up within the entire sample and remained a significant predictor of treatment outcome even when other predictive cofactors (i.e., pain interference, depressive symptoms, and catastrophizing) were considered simultaneously. Our results suggest that identifying patients with a co-occurrence between alexithymia, depressive symptoms, catastrophizing, and the stressful experience of chronic pain can be clinically relevant in pain prevention and intervention programs.
慢性疼痛具有复杂和多维的性质，在确定有效的长期治疗方法方面带来了重大挑战。科学越来越关注心理病理和人格维度如何影响慢性疼痛的维持和发展。这项纵向研究旨在调查是否存在躯体化障碍可以预测常规治疗慢性肌肉骨骼疼痛方案治疗后疼痛严重程度的改善，而不仅仅是心理因素（情绪困扰、灾难化和自我效能感）。从两个三级护理中心招募了 129 名被诊断患有慢性肌肉骨骼疼痛的连续患者，并对他们进行了 16 周的治疗。在第一次就诊（T0）和 16 周随访（T1）时，使用经过验证的自我报告量表评估了临床疼痛、心理困扰、自我效能感、灾难化和躯体化障碍。与非应答者患者（n=72，55.8%）相比，应答者患者（即疼痛严重程度降低>30%；n=57，44.2%）报告除躯体化障碍外，心理变量总体有所改善。在整个样本中，躯体化障碍在基线和随访之间表现出相对稳定性，即使同时考虑到其他预测性协变量（即疼痛干扰、抑郁症状和灾难化），它仍然是治疗结果的重要预测因素。我们的研究结果表明，在疼痛预防和干预计划中，识别出同时存在躯体化障碍、抑郁症状、灾难化和慢性疼痛带来的压力体验的患者可能具有临床意义。
