The reciprocal associations between catastrophizing and pain outcomes in patients being treated for neuropathic pain: a cross-lagged panel analysis study
The reciprocal associations between catastrophizing and pain outcomes in patients being treated for neuropathic pain: a cross-lagged panel analysis study
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DOI：
10.1097/j.pain.0000000000000594
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发表时间：
2016-09-01
期刊：
影响因子：
7.4
通讯作者：
Jensen, Mark P.
中科院分区：
文献类型：
--
作者：
Racine, Melanie;Moulin, Dwight E.;Jensen, Mark P.
灾难化被认为是慢性疼痛患者疼痛相关负面结果的关键社会心理因素。为了更好地理解这些构念之间的时间关系，需要进行纵向研究。本研究的目的是确定治疗早期灾难化的变化是否预测了治疗后期疼痛强度和干扰的变化，或者反过来，疼痛强度和干扰的早期变化是否预测了随后的灾难化变化。从加拿大6个多学科疼痛诊所招募了538名神经性疼痛患者。研究参与者被要求在首次就诊时完成灾难、疼痛强度和干扰的测量，然后在3个月和6个月的随访中再次进行测量。交叉滞后面板分析用于确定研究变量之间的时间关联。结果表明，治疗早期灾难化的减少预示着治疗后期疼痛强度和干扰的改善。相反的时间关系也被发现，在治疗早期疼痛强度和干扰的减少预示着随后灾难化的减少。所有4个独特的交叉滞后相关性显著地占总方差的4%到7%。这些发现与假设灾难化对疼痛的因果影响的理论模型一致，表明这些因素之间存在相互因果关系。结果支持以灾难化为目标的治疗可能会影响其他疼痛相关的结果，相反，旨在减轻疼痛的治疗可能会影响灾难化。因此，通往积极结果的道路可能有多种。
Catastrophizing is recognized as a key psychosocial factor associated with pain-related negative outcomes in individuals with chronic pain. Longitudinal studies are needed to better understand the temporal relationship between these constructs. The aim of this study was to determine if changes in catastrophizing early in treatment predicted subsequent changes in pain intensity and interference later in treatment, or alternately, if early changes in pain intensity and interference predicted subsequent changes in catastrophizing. A total of 538 patients with neuropathic pain were recruited from 6 multidisciplinary pain clinics across Canada. Study participants were asked to complete measures of catastrophizing, pain intensity, and interference when first seen in the clinic and then again at 3- and 6-month follow-ups. Cross-lagged panel analyses were used to determine the temporal associations among the study variables. The results showed that decreases in catastrophizing early in treatment prospectively predicted improvement in both pain intensity and interference later in treatment. Converse temporal relationships were also found, where a reduction in pain intensity and interference early in treatment predicted a subsequent diminishing of catastrophizing. All 4 unique cross-lagged correlations significantly accounted for an additional 4% to 7% of the total variance. The findings are consistent with theoretical models hypothesizing a causal impact of catastrophizing on pain, suggesting a mutual causation between these factors. The results support that treatments targeting catastrophizing may influence other pain-related outcomes, and conversely that treatments aiming to reduce pain could potentially influence catastrophizing. There may therefore be multiple paths to positive outcomes.