Rassu Fenan S, Bhattiprolu Kavya, Campbell Claudia M, Wegener Stephen T, Aaron Rachel V
Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation, USA.
Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation, USA.
J Pain. 2025 Feb;27:104744. doi: 10.1016/j.jpain.2024.104744. Epub 2024 Nov 23.
This study investigated the relationship between neighborhood disadvantage, measured by the Area Deprivation Index (ADI), and pain-related variables in a pain psychology clinic. We also examined the sequential mediating roles of pain catastrophizing and pain-related fear on these relationships. Participants (N = 509) completed questionnaires assessing usual pain intensity, fatigue, emotional distress, and interference with daily activities. The mean ADI score was 32.57 (SD = 22.65), with scores ranging from 1 to 100. Linear regression analysis, adjusting for age and gender, revealed that higher ADI (i.e., less advantage) was significantly associated with higher scores on pain-related variables (pain intensity: B = 0.026, p < .001; fatigue: B = 0.018, p < .001; emotional distress: B = 0.020, p < .001; interference with daily activities: B = 0.014, p = .006). Sequential mediation analysis revealed pain catastrophizing and pain-related fear mediated these relationships, with significant indirect effects for fatigue (B = 0.001, 95% CI [0.000, 0.002]) and interference with daily activities (B = 0.001, 95% CI [0.001, 0.003]) - but not pain intensity or emotional distress. Pain catastrophizing alone mediated neighborhood disadvantage-pain relationship for all variables. The results suggest that neighborhood disadvantage is associated with higher scores on pain-related experiences and that consistent with the fear avoidance model, pain catastrophizing and pain-related fear may play a role in these relationships for fatigue and interference with daily activities. These findings underscore that neighborhood disadvantage is associated with worse pain-related experiences and highlight the importance of considering neighborhood factors in chronic pain management. PERSPECTIVE: This study identifies potential pathways linking neighborhood disadvantage to chronic pain variables, highlighting the roles of pain catastrophizing and pain-related fear. The findings underscore the need for a holistic approach to pain management that recognizes both individual cognitive-emotional factors and the broader social context in which pain occurs.
本研究在一家疼痛心理学诊所中，调查了以区域剥夺指数（ADI）衡量的邻里劣势与疼痛相关变量之间的关系。我们还检验了疼痛灾难化和疼痛相关恐惧在这些关系中的顺序中介作用。参与者（N = 509）完成了评估日常疼痛强度、疲劳、情绪困扰以及对日常活动干扰的问卷。ADI平均得分为32.57（标准差 = 22.65），分数范围为1至100。在对年龄和性别进行调整的线性回归分析中，结果显示较高的ADI（即较少优势）与疼痛相关变量的较高得分显著相关（疼痛强度：B = 0.026，p <.001；疲劳：B = 0.018，p <.001；情绪困扰：B = 0.020，p <.001；对日常活动的干扰：B = 0.014，p =.006）。顺序中介分析显示，疼痛灾难化和疼痛相关恐惧介导了这些关系，对疲劳（B = 0.001，95%置信区间[0.000，0.002]）和对日常活动的干扰（B = 0.001，95%置信区间[0.001，0.003]）有显著间接效应——但对疼痛强度或情绪困扰没有。仅疼痛灾难化就介导了所有变量的邻里劣势与疼痛的关系。结果表明，邻里劣势与疼痛相关经历的较高得分相关，并且与恐惧回避模型一致，疼痛灾难化和疼痛相关恐惧可能在疲劳和对日常活动干扰的这些关系中起作用。这些发现强调邻里劣势与更差的疼痛相关经历相关，并突出了在慢性疼痛管理中考虑邻里因素的重要性。观点：本研究确定了将邻里劣势与慢性疼痛变量联系起来的潜在途径，突出了疼痛灾难化和疼痛相关恐惧的作用。这些发现强调了需要一种整体的疼痛管理方法，该方法既要认识到个体认知 - 情感因素，也要认识到疼痛发生的更广泛社会背景。
