Clinical Pain Catastrophizing in Women With Migraine and Obesity.
Clinical Pain Catastrophizing in Women With Migraine and Obesity.
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作者：
Bond DS;Buse DC;Lipton RB;Thomas JG;Rathier L;Roth J;Pavlovic JM;Evans EW;Wing RR
肥胖与偏头痛有关。适应不良的疼痛应对策略（例如，疼痛灾难化）可以提供对这种关系的洞察。在患有偏头痛和肥胖的女性中，我们横断面评估了：1)临床灾难化的患病率；2)有无临床灾难化的特点；3)灾难化与头痛特征的关联。寻求减肥治疗的肥胖女性偏头痛患者（n=105）通过智能手机记录了1个月的每日偏头痛活动，并完成了疼痛灾难量表（PCS）。临床灾变定义为PCS总分≥30分。同时进行头痛影响测试（HIT-6）、异常性疼痛症状检查表（ASC-12）、头痛管理自我效能量表（HMSE）、抑郁评估（CES-D）和焦虑评估（GAD-7）。使用PCS评分和身体质量指数（BMI）作为线性回归的预测因子，我们模拟了一系列头痛特征（即头痛天数、HIT-6等）作为结果。四分之一（25.7%;95%CI= 17.2%-34.1%）的参与者符合临床灾难化标准：与没有临床灾难化的参与者相比，他们有更高的BMI(37.9±7.5 vs. 34.4±5.7 kg/m2, p=0.035)，更长的偏头痛发作时间（160.8±145.0 vs. 97.5±75.2小时/月，p=0.038），更高的hit6评分（68.7±4.6 vs. 64.5±3.9,p<0.001），更多的异常性疼痛（7.0±4.1 vs. 4.5±3.5,p<0.003），抑郁（25.4±12.4 vs. 13.3±9.2,p<0.001），焦虑（11.0±5.2 vs. 5.6±4.1,p<0.001），更低的自我效能（80.1±25.6 vs. 104.7±18.9,p<0.001）。有（n=8/29.6%）临床灾难化的患者患慢性偏头痛的几率比没有（n=8/10.3%）临床灾难化的患者高近4倍（OR=3.68;95%CI= 1.22-11.10, p=0.021）。在所有参与者中，较高的PCS评分与偏头痛天数较多（β=0.331, p=0.001）、发作持续时间较长（β=0.390, p<0.001）、HIT-6评分较高（β=0.425, p<0.001）和HMSE评分较低（β= - 0.437, p<0.001）相关。BMI越高，发作频率越高（β= - 0.203, p=0.044）。四分之一患有偏头痛和肥胖症的参与者报告了临床灾难。这些个体有更频繁的发作/慢性发作、更长的发作持续时间、更高的疼痛敏感性、更大的头痛影响和更低的头痛管理自我效能感。在所有参与者中，PCS分数与偏头痛的几个特征有关，超出了肥胖的影响。需要前瞻性研究来确定灾难化、肥胖和偏头痛之间关系的顺序和机制。
Obesity is related to migraine. Maladaptive pain coping strategies (e.g., pain catastrophizing), may provide insight into this relationship. In women with migraine and obesity, we cross-sectionally assessed: 1) prevalence of clinical catastrophizing; 2) characteristics of those with and without clinical catastrophizing; and 3) associations of catastrophizing with headache features. Obese women migraineurs seeking weight loss treatment (n=105) recorded daily migraine activity for 1-month via smartphone and completed the Pain Catastrophizing Scale (PCS). Clinical catastrophizing was defined as total PCS score ≥30. The Headache Impact Test (HIT-6), Allodynia Symptom Checklist (ASC-12), Headache Management Self-Efficacy Scale (HMSE), and assessments for depression (CES-D) and anxiety (GAD-7) were also administered. Using PCS scores and Body Mass Index (BMI) as predictors in linear regression, we modeled a series of headache features (i.e., headache days, HIT-6, etc.) as outcomes. One-quarter (25.7%;95%CI=17.2%–34.1%) of participants met criteria for clinical catastrophizing: they had higher BMI(37.9±7.5 vs. 34.4±5.7 kg/m2, p=0.035), longer migraine attack duration(160.8±145.0 vs. 97.5±75.2 hours/month, p=0.038), higher HIT-6 scores(68.7±4.6 vs. 64.5±3.9, p<0.001), more allodynia(7.0±4.1 vs. 4.5±3.5, p<0.003), depression(25.4±12.4 vs. 13.3±9.2, p<0.001), and anxiety(11.0±5.2 vs. 5.6±4.1, p<0.001), and lower self-efficacy(80.1±25.6 vs. 104.7±18.9, p<0.001) compared to participants without clinical catastrophizing. The odds of chronic migraine were nearly 4-fold greater in those with (n=8/29.6%) versus without (n=8/10.3%) clinical catastrophizing (OR=3.68;95%CI=1.22–11.10, p=0.021). In all participants, higher PCS scores were related to more migraine days(β=0.331, p=0.001), longer attack duration(β=0.390, p<0.001), higher HIT-6 scores(β=0.425, p<0.001), and lower HMSE scores (β=−0.437, p<0.001). Higher BMI, but not higher PCS scores, was related to more frequent attacks (β=−0.203, p=0.044). One-quarter of participants with migraine and obesity reported clinical catastrophizing. These individuals had more frequent attacks/chronicity, longer attack duration, higher pain sensitivity, greater headache impact, and lower headache management self-efficacy. In all participants, PCS scores were related to several migraine characteristics, above and beyond the effects of obesity. Prospective studies are needed to determine sequence and mechanisms of relationships between catastrophizing, obesity, and migraine.