Teichmüller Karolin, Kübler Andrea, Rittner Heike L, Kindl Gudrun-Karin
University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, Würzburg, Germany.
University of Würzburg, Institute of Psychology, Department of Psychology I, Würzburg, Germany.
J Pain Res. 2024 Jul 25;17:2473-2481. doi: 10.2147/JPR.S464509. eCollection 2024.
The Avoidance-Endurance Model postulates fear-avoidance responses and endurance responses as important psychological mechanisms in the development and maintenance of chronic pain. The present study aims to investigate potential differences in avoidance and endurance responses to pain before and with advanced chronification.
Two samples of adults with non-cancer pain at two different stages of chronicity were compared: One with pain and risk factors for chronicity (n=26, part of the PAIN2020 project) and one with chronic pain (n=33 from a pain day care clinic). The German Pain Questionnaire, the Graded Chronic Pain Scale (GCPS) and medical reports were used to measure duration and severity of pain. Responses to pain were assessed with the Avoidance-Endurance Questionnaire (AEQ) and psychological strain with the Depression, Anxiety and Stress Scales (DASS).
Both groups were primarily affected by musculoskeletal pain. Although not yet chronified, the risk group reported comparable GCPS levels of pain intensity and disability. Depression and stress ratings were also similar, except for anxiety, which was significantly elevated in the chronic pain sample (<.001). The AEQ scales did not differ between groups, neither on any of the fear-avoidance- nor endurance-related dimensions. A post-hoc regression analysis revealed a significant prediction of fear-avoidance by pain-related disability (<.001). The regression model for endurance responses was not significant.
Patients with risk factors of chronification experience substantial pain-related burden. Responses to pain in the realm of the Avoidance-Endurance model do not appear to vary as a function of chronification. While fear-avoidance and pain-related disability correlate positively, endurance could not be associated to any of our variables.
回避-耐受模型假定恐惧回避反应和耐受反应是慢性疼痛发生和维持过程中的重要心理机制。本研究旨在调查在慢性疼痛发展之前以及发展到晚期时，对疼痛的回避和耐受反应的潜在差异。
比较了处于慢性疼痛两个不同阶段的两组非癌性疼痛成年患者样本：一组有疼痛且有慢性化风险因素（n = 26，PAIN2020项目的一部分），另一组为慢性疼痛患者（来自疼痛日间护理诊所的33例）。使用德国疼痛问卷、慢性疼痛分级量表（GCPS）和医疗报告来测量疼痛的持续时间和严重程度。用回避-耐受问卷（AEQ）评估对疼痛的反应，用抑郁、焦虑和压力量表（DASS）评估心理压力。
两组主要受肌肉骨骼疼痛影响。尽管尚未慢性化，但有慢性化风险的组报告的GCPS疼痛强度和残疾水平相当。抑郁和压力评分也相似，但焦虑除外，慢性疼痛样本中的焦虑显著升高（<.001）。两组之间的AEQ量表在任何与恐惧回避或耐受相关的维度上均无差异。事后回归分析显示，与疼痛相关的残疾对恐惧回避有显著预测作用（<.001）。耐受反应的回归模型不显著。
有慢性化风险因素的患者经历了与疼痛相关的沉重负担。在回避-耐受模型范围内，对疼痛的反应似乎不会因慢性化程度而有所不同。虽然恐惧回避与疼痛相关残疾呈正相关，但耐受与我们的任何变量均无关联。
