Knox Patrick J, Simon Corey B, Pohlig Ryan T, Pugliese Jenifer M, Coyle Peter C, Sions Jaclyn M, Hicks Gregory E
Departments of Physical Therapy.
Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC.
Clin J Pain. 2025 Jul 1;41(7):e1294. doi: 10.1097/AJP.0000000000001294.
Although pain quality may be a component of the geriatric chronic pain experience that influences disability, no research has investigated the psychological underpinnings of pain quality in any geriatric chronic pain population. We sought to address this knowledge gap by examining associations between both general (ie, depressive symptoms) and pain-specific psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) and prospective pain quality in older adults with chronic low back pain.
Questionnaires for each psychological factor were collected at baseline, while pain quality was measured by the McGill Pain Questionnaire at baseline and 12 months. Preliminary analyses identified pain catastrophizing as the individual factor with the highest correlation to future pain quality for subsequent analyses. To assess if baseline psychological factors were cumulatively associated with 12-month pain quality, questionnaire values were entered into principal component analysis to yield a combined psychological component score. Robust regression models with HC3 standard errors were used to examine associations between baseline psychological risk factors (both individually and cumulatively) and prospective pain quality.
In adjusted analyses, higher baseline pain catastrophizing independently predicted worse pain quality at 12 months ( b =0.342, t =4.225, P <0.001). Similarly, higher baseline psychological component scores were independently associated with worse prospective pain quality after adjustment ( b =3.816, t =4.518, P <0.001).
The combined psychological component score had comparatively stronger predictive ability than pain catastrophizing alone; however, overall model prediction was modest, suggesting that future research is needed to identify other biopsychosocial variables that may impact pain quality in the geriatric chronic LBP population.
尽管疼痛性质可能是老年慢性疼痛体验中影响残疾状况的一个因素，但尚无研究调查任何老年慢性疼痛人群中疼痛性质的心理基础。我们试图通过研究一般（即抑郁症状）和疼痛特异性心理风险因素（即恐惧回避信念、疼痛灾难化和运动恐惧）与慢性下腰痛老年人的前瞻性疼痛性质之间的关联，来填补这一知识空白。
在基线时收集每个心理因素的问卷，同时在基线和12个月时用麦吉尔疼痛问卷测量疼痛性质。初步分析确定疼痛灾难化为与未来疼痛性质相关性最高的个体因素，用于后续分析。为了评估基线心理因素是否与12个月时的疼痛性质累积相关，将问卷值输入主成分分析以得出综合心理成分得分。使用具有HC3标准误的稳健回归模型来检验基线心理风险因素（单独和累积）与前瞻性疼痛性质之间的关联。
在调整分析中，较高的基线疼痛灾难化独立预测12个月时更差的疼痛性质（b = 0.342，t = 4.225，P < 0.001）。同样，较高的基线心理成分得分在调整后与更差的前瞻性疼痛性质独立相关（b = 3.816，t = 4.518，P < 0.001）。
综合心理成分得分的预测能力比单独的疼痛灾难化更强；然而，总体模型预测效果一般，这表明未来需要开展研究以确定其他可能影响老年慢性下腰痛人群疼痛性质的生物心理社会变量。
