What do you expect? Catastrophizing mediates associations between expectancies and pain-facilitatory processes
What do you expect? Catastrophizing mediates associations between expectancies and pain-facilitatory processes
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DOI：
10.1002/ejp.1348
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发表时间：
2019-04-01
影响因子：
3.6
通讯作者：
Edwards, Robert R.
中科院分区：
文献类型：
--
作者：
Carriere, Junie S.;Martel, Marc Olivier;Edwards, Robert R.
背景疼痛预期与慢性疼痛患者疼痛敏感性的改变有关。然而，很少有人知道的过程中，疼痛的预期影响疼痛处理。本研究评估了疼痛预期和疼痛时间总和（TS）之间的关联，并研究了疼痛灾难化是否介导了这种关联。方法在这项横断面研究中，参与者（437例慢性下腰痛[CLBP]患者，115名对照）在接受旨在评估机械性疼痛的机械性TS的心理物理疼痛测试程序之前，完成了疼痛强度，疼痛预期和疼痛灾难性的自我报告措施。Pearson相关性检验了CLBP患者和对照组研究变量之间的关联。自举中介分析评估疼痛灾难化对疼痛预期和疼痛TS之间关联的中介作用。结果CLBP患者的疼痛时间总和与疼痛预期（r = 0.113）和疼痛灾难性（r = 0.171）显著相关。中介分析结果显示，疼痛灾难化在CLBP患者中介导了疼痛预期与疼痛TS之间的关系（ab = 0.309，95%CI = 0.1222-0.5604），但在健康对照组中没有介导（ab =-0.125，95%CI = -0.5864至0.0244）。结论与对照组相比，CLBP患者对机械性疼痛的敏感性增加，疼痛易化过程增强，进一步证明了CLBP患者中枢神经系统疼痛过程的改变。我们的研究结果还表明，疼痛灾难化可能是CLBP患者疼痛预期与疼痛TS相关的机制。意义：慢性腰痛患者预期疼痛水平更高并对疼痛灾难化的患者更有可能经历疼痛敏感性的改变。我们的研究结果指出，灾难化作为一种行动机制，通过这种机制，心理因素可能会发挥作用，并导致慢性腰痛的发展和维持。
Background Pain expectancies are associated with altered pain sensitivity in individuals with chronic pain. However, little is known about the processes by which pain expectancies impact pain processing. This study assessed the association between pain expectancies and temporal summation (TS) of pain, and examined whether pain catastrophizing mediated this association. Methods In this cross-sectional study, participants (437 chronic low back pain [CLBP] patients, 115 controls) completed self-report measures of pain intensity, pain expectancies and pain catastrophizing before undergoing psychophysical pain-testing procedures designed to assess mechanical TS of mechanical pain. Pearson's correlations examined the associations between study variables in CLBP patients and controls. Bootstrapping mediation analyses assessed the mediating role of pain catastrophizing on the association between pain expectancies and TS of pain. Results Temporal summation of pain was significantly associated with pain expectancies (r = 0.113) and pain catastrophizing (r = 0.171) in CLBP patients. Results of mediation analyses revealed that pain catastrophizing mediated the relationship between pain expectancies and TS of pain in CLBP patients (ab = 0.309, 95% CI = 0.1222-0.5604), but not in healthy controls (ab = -0.125, 95% CI = -0.5864 to 0.0244). Conclusions The findings from this study suggest that compared to controls, CLBP patients show increased sensitivity to mechanical pain procedures and enhanced pain-facilitatory processing, proving further evidence for changes in central nervous system pain processing in CLBP patients. Our results also suggest that pain catastrophizing may be the mechanism by which pain expectancies are associated with TS of pain in CLBP patients Significance: Individuals with chronic low back pain who expect higher levels of pain and catastrophize about their pain are more likely to experience altered pain sensitivity. Our results point to catastrophizing as a mechanism of action through which psychological factors may operate and lead to the development and maintenance of chronic low back pain.