Schanberg Laura E, Lefebvre John C, Keefe Francis J, Kredich Deborah W, Gil Karen M
Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA Department of Psychology, University of North Carolina, Chapel Hill, NC 27599, USA.
Pain. 1997 Nov;73(2):181-189. doi: 10.1016/S0304-3959(97)00110-3.
This study examined the pain experience and pain coping of children with juvenile chronic arthritis (JCA). The purpose of the study was to describe present pain and the pain coping strategies utilized by children with juvenile chronic arthritis and examine pain coping strategies and pain efficacy as a predictor of pain intensity and distribution. Fifty-six children with JCA rated their present pain using two measures of pain intensity, the Oucher and the pain thermometer, and reported on the number of pain locations using a body map. In addition, each child completed the Child Version of the Coping Strategies Questionnaire (CSQ-C) and health status was determined by a physician's disease activity rating. On average, children reported current pain in the low to middle range on the different pain scales, although there was considerable variability in pain ratings. Up to 30% of all children had pain ratings higher than or equal to the middle range on both the Oucher and the pain thermometer. On average, children reported pain in more than two body areas. Correlational analyses were conducted to examine how the composite factors on the CSQ-C (Pain Control and Rational Thinking, and Coping Attempts) related to variations in reported pain intensity and location. Children who scored higher on the Pain Control and Rational Thinking factor of the CSQ-C had much lower ratings of pain intensity and reported pain in fewer body areas. Hierarchical regression analyses indicated that disease activity and scores on the Pain Control and Rational Thinking factor of the CSQ-C each accounted for a unique, statistically significant proportion of variance in the measures of pain intensity and pain location. Behavioral and cognitive therapy interventions designed to increase pain coping efficacy may be useful adjuncts in treating pain in children with chronic arthritis.
本研究考察了青少年慢性关节炎（JCA）患儿的疼痛体验及疼痛应对方式。研究目的是描述青少年慢性关节炎患儿当前的疼痛情况以及所采用的疼痛应对策略，并检验疼痛应对策略和疼痛效能作为疼痛强度及分布预测指标的情况。56名青少年慢性关节炎患儿使用两种疼痛强度测量工具——奥ucher量表和疼痛温度计对他们当前的疼痛进行评分，并通过身体图报告疼痛部位的数量。此外，每个孩子都完成了儿童版应对策略问卷（CSQ-C），健康状况由医生的疾病活动评分确定。平均而言，孩子们在不同疼痛量表上报告的当前疼痛处于低到中等范围，尽管疼痛评分存在相当大的差异。在所有孩子中，高达30%的孩子在奥ucher量表和疼痛温度计上的疼痛评分高于或等于中等范围。平均而言，孩子们报告在两个以上身体部位有疼痛。进行了相关分析，以检验CSQ-C上的综合因素（疼痛控制与理性思维以及应对尝试）与报告的疼痛强度和部位变化之间的关系。在CSQ-C的疼痛控制与理性思维因素上得分较高的孩子，疼痛强度评分要低得多，且报告疼痛的身体部位较少。分层回归分析表明，疾病活动以及CSQ-C的疼痛控制与理性思维因素得分各自在疼痛强度和疼痛部位测量指标的方差中占独特的、具有统计学意义的比例。旨在提高疼痛应对效能的行为和认知疗法干预措施可能是治疗慢性关节炎患儿疼痛的有用辅助手段。
