Cognitive-behavioral determinants of pain and disability two years after traumatic injury: A cross-sectional survey study
Cognitive-behavioral determinants of pain and disability two years after traumatic injury: A cross-sectional survey study
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DOI：
10.1097/ta.0b013e3182245ece
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发表时间：
2012-02-01
影响因子：
3.4
通讯作者：
Obremskey, William T.
中科院分区：
文献类型：
--
作者：
Archer, Kristin R.;Abraham, Christine M.;Obremskey, William T.
背景：每年大约有 250 万创伤幸存者住院，其中大多数人经历了长期且严重的疼痛相关残疾。本研究调查了高能量创伤后 2 年后对运动的恐惧与灾难性疼痛以及疼痛与身体健康之间的关系。 方法：2006 年 7 月至 2007 年 7 月间，在多发性创伤 2 年后，通过电话联系了 108 名被送往一级创伤重症监护病房的成年患者。八十四名 (78%) 参与者完成了对运动的恐惧、疼痛灾难性、疼痛强度和对活动的干扰以及身体健康的测量。从医疗记录和研究数据库中提取患者和受伤特征。分层多变量线性回归分析检查了对运动和灾难性疼痛的恐惧对疼痛和身体健康结果的独特贡献。结果：在控制了年龄、性别、重症监护病房住院时间和抑郁症后，对运动和灾难性疼痛的恐惧解释了疼痛强度（29%）、疼痛干扰（34%）和身体健康（19%）的很大一部分差异。对运动的恐惧和疼痛灾难化与疼痛强度和身体健康独立相关，但只有疼痛灾难化与疼痛干扰相关（p < 0.05）。结论：结果表明，对运动和灾难化的恐惧是创伤后长期结果不佳的危险因素。有必要进行前瞻性研究来测试恐惧回避模型，并确定该模型是否有助于解释创伤幸存者慢性疼痛和残疾的发展。基于消极疼痛信念的亚组识别可能有可能改善创伤后的结果。 （J Trauma。2012 年；72：473-479。版权所有 (C) 2012，Lippincott Williams & Wilkins）
BACKGROUND: Approximately, 2.5 million trauma survivors are hospitalized each year, with the majority experiencing prolonged and profound pain-related disability. The present study investigated the association between fear of movement and pain catastrophizing and pain and physical health 2 years after high-energy trauma.METHODS: One hundred eight adult patients admitted to a Level I trauma intensive care unit, between July 2006 and July 2007, were contacted by phone 2 years after multiple trauma. Eighty-four (78%) participants completed measures of fear of movement, pain catastrophizing, pain intensity and interference with activity, and physical health. Patient and injury characteristics were abstracted from the medical record and a research database. Hierarchical multivariable linear regression analyses examined the unique contribution of fear of movement and pain catastrophizing to pain and physical health outcomes.RESULTS: Fear of movement and catastrophizing explained a significant proportion of variance in pain intensity (29%), pain interference (34%), and physical health (19%), after controlling for age, sex, intensive care unit stay, and depression. Fear of movement and pain catastrophizing were independently associated with pain intensity and physical health, but only pain catastrophizing was associated with pain interference (p < 0.05).CONCLUSIONS: Results suggest that fear of movement and catastrophizing are risk factors for poor long-term outcomes after traumatic injury. Prospective studies are warranted to test the fear-avoidance model and determine whether the model may be relevant for explaining the development of chronic pain and disability in trauma survivors. The identification of subgroups based on negative pain beliefs may have the potential to improve outcomes after traumatic injury. (J Trauma. 2012; 72: 473-479. Copyright (C) 2012 by Lippincott Williams & Wilkins)