Fentazi Delia, Pester Bethany D, Yamin Jolin B, Jamison Robert N, Edwards Robert R, Meints Samantha M
Graduate School of Medical Science, Boston University, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Management, Brigham and Women's Hospital, Boston, MA, United States.
Graduate School of Medical Science, Boston University, Boston, MA, United States; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States.
J Pain. 2025 Feb;27:104764. doi: 10.1016/j.jpain.2024.104764. Epub 2024 Dec 24.
Lower educational attainment has been linked to worse pain in individuals with chronic pain, but the mechanisms of this relationship are not fully elucidated. This observational study analyzed the relationship between educational attainment and pain in patients with fibromyalgia (FM) and the potential psychological mechanisms driving this relationship. We hypothesized that (1) lower educational attainment would be associated with greater pain intensity and interference, and that (2) concerns about pain (CAP), anxiety, and depression would mediate the relationship between educational attainment and pain. A total of 119 adults (93.3% female, 79.7% White, Mage=50.4) with FM completed questionnaires including demographics, Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scales (HADS). Pearson correlations and bootstrapped mediation analyses were conducted to examine the relationships among education, psychological variables, and pain variables. Education was inversely correlated with pain intensity and interference, CAP, anxiety, and depression (p<.05). CAP significantly mediated the relationship between education and pain intensity (95% CI [0.151, 0.026]), while both CAP and depression mediated the effects of education on pain interference (95% CI [0.195, -0.025]; 95% CI [-0.163, -0.004]). However, anxiety did not mediate either relationship. These findings suggest that greater CAP, and in part depression, may be possible mechanisms in the relationships between lower educational attainment and worse pain intensity and interference. This work has important implications in reducing pain disparities and provides direction for psychological treatment, suggesting that both depression and CAP may be critical targets especially for people with lower education attainment. PERSPECTIVES: This study examined the relationship between educational attainment, psychological variables, and pain. Results have implications for psychological intervention aimed at concerns about pain and depression, especially among individuals with low educational attainment.
教育程度较低与慢性疼痛患者的疼痛加剧有关，但这种关系的机制尚未完全阐明。这项观察性研究分析了纤维肌痛（FM）患者的教育程度与疼痛之间的关系，以及驱动这种关系的潜在心理机制。我们假设：（1）教育程度较低与更高的疼痛强度和干扰相关；（2）对疼痛的担忧（CAP）、焦虑和抑郁将介导教育程度与疼痛之间的关系。共有119名患有FM的成年人（93.3%为女性，79.7%为白人，平均年龄50.4岁）完成了问卷调查，内容包括人口统计学信息、简明疼痛量表（BPI）、疼痛灾难化量表（PCS）和医院焦虑抑郁量表（HADS）。进行了Pearson相关性分析和自抽样中介分析，以检验教育、心理变量和疼痛变量之间的关系。教育程度与疼痛强度、干扰、CAP、焦虑和抑郁呈负相关（p<0.05）。CAP显著介导了教育程度与疼痛强度之间的关系（95%CI[0.151，0.026]），而CAP和抑郁均介导了教育程度对疼痛干扰的影响（95%CI[0.195，-0.025]；95%CI[-0.163，-0.004]）。然而，焦虑并未介导任何一种关系。这些发现表明，更多的CAP以及部分抑郁可能是教育程度较低与更严重的疼痛强度和干扰之间关系的潜在机制。这项工作对于减少疼痛差异具有重要意义，并为心理治疗提供了方向，表明抑郁和CAP可能是关键靶点，尤其是对于教育程度较低的人群。观点：本研究考察了教育程度、心理变量和疼痛之间的关系。研究结果对针对疼痛担忧和抑郁的心理干预具有启示意义，尤其是在教育程度较低的个体中。
