Haythornthwaite Jennifer A, Menefee Lynette A, Heinberg Leslie J, Clark Michael R
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Meyer 218, 600 N. Wolfe St., Baltimore, MD 21287-7218, USA Jefferson Medical College, Baltimore, MD, USA.
Pain. 1998 Jul;77(1):33-39. doi: 10.1016/S0304-3959(98)00078-5.
Perceptions of control over pain and specific pain coping strategies are associated with a number of positive outcomes in patients with chronic pain conditions. Transactional models of stress have emphasized coping as a process that is both determined by, and influences appraisals of control. While perceptions of control and coping efforts are associated with better adjustment, little is known about the specific coping strategies that contribute to perceptions that pain is controllable. One hundred and ninety-five (65% female) individuals with chronic pain conditions admitted to an inpatient unit completed the Multidimensional Pain Inventory, the Survey of Pain Attitudes and the Coping Strategies Questionnaire. Stepwise multiple regression analyses were used to predict perceived pain control from measures of pain severity and coping. After controlling for pain severity and education, coping self-statements and reinterpreting pain sensations predicted greater perceptions of control over pain, whereas ignoring pain sensations predicted lower perceptions of control over pain. The coping strategies did not interact with pain severity in predicting perceptions of control. Coping flexibility, or the number of pain coping strategies reported at a high frequency, also predicted perceptions of control over pain and did not interact with pain severity. The present findings suggest that, regardless of pain severity, the use of specific cognitive pain coping strategies may increase perceptions of control over pain. Since the existing coping literature largely identifies maladaptive pain coping strategies, it is especially critical to establish which pain coping strategies are adaptive. Specific cognitive strategies, particularly coping self statements, are important components for cognitive-behavioral interventions for chronic pain management. Future research will need to determine whether other adaptive cognitive strategies such as reinterpreting pain sensations can be increased with cognitive interventions, since this strategy is infrequently used.
对疼痛控制的认知以及特定的疼痛应对策略与慢性疼痛患者的一系列积极结果相关。压力的交互作用模型强调应对是一个既由控制评估决定又影响控制评估的过程。虽然对控制的认知和应对努力与更好的适应相关，但对于促成疼痛可控认知的具体应对策略却知之甚少。195名（65%为女性）入住住院部的慢性疼痛患者完成了多维疼痛量表、疼痛态度调查和应对策略问卷。采用逐步多元回归分析从疼痛严重程度和应对措施来预测感知到的疼痛控制。在控制了疼痛严重程度和教育程度后，应对自我陈述和重新诠释疼痛感觉预测了对疼痛更大的控制感，而忽视疼痛感觉则预测了对疼痛较低的控制感。应对策略在预测控制感时与疼痛严重程度没有交互作用。应对灵活性，即高频报告的疼痛应对策略的数量，也预测了对疼痛的控制感，并且与疼痛严重程度没有交互作用。目前的研究结果表明，无论疼痛严重程度如何，使用特定的认知疼痛应对策略可能会增加对疼痛的控制感。由于现有的应对文献在很大程度上确定了适应不良的疼痛应对策略，确定哪些疼痛应对策略是适应性的尤为关键。特定的认知策略，尤其是应对自我陈述，是慢性疼痛管理认知行为干预的重要组成部分。未来的研究需要确定其他适应性认知策略，如重新诠释疼痛感觉，是否可以通过认知干预来增加，因为这种策略很少被使用。
