慢性退行性腰痛病人灾难化思想与功能状态的关系:疼痛接受的中介效应

Relationship between catastrophic thinking and functional status among elderly patients with chronic degenerative low back pain:the mediating effect of pain acceptance

[目的]探讨老年慢性退行性腰痛病人的疼痛接受程度在灾难化思想与功能状态之间的中介作用。[方法]选取慢性退行性腰痛病人213例,采用疼痛灾难化量表(PCS)、简易疼痛接受问卷(CPAQ⁃8)和简明健康调查问卷(SF⁃12)进行测量,应用逐步回归分析和Bootstrap法检验疼痛接受在灾难化思想与功能状态中的中介作用。[结果]PCS得分与CPAQ⁃8得分、SF⁃12中躯体健康(PCS)得分和心理健康(MCS)得分均呈负相关;CPAQ⁃8与躯体健康得分和心理健康得分均呈正相关。回归分析和Bootstrap法检验结果显示,灾难化思想对病人躯体健康的直接效应为-0.27,95%CI(-0.49,-0.05),以疼痛接受为中介的间接效应为-0.16,95%CI(-0.29,-0.005);灾难化思想对病人心理健康的直接效应为-0.32,95%CI(-0.47,-0.17),以疼痛接受为中介的间接效应为-0.16,95%CI(-0.28,-0.01)。[结论]疼痛接受在慢性退行性腰痛病人灾难化思想与功能状态的关系中起部分中介作用,应重视疼痛接受的中介效应,采取相应措施提高病人疼痛接受程度,进而改善其躯体、心理功能状态。

Objective:To explore the mediating effect of pain acceptance in catastrophic thinking and functional status among patients with chronic degenerative low back pain.Methods:A total of 213 patients with chronic degenerative low back pain were recruited.Pain Catatrophizing Scale(PCS),the Chronic Pain Acceptance Questionnaire(CPAQ⁃8)and the 12⁃items Short Form Health Survey(SF⁃12)were adopted.Regression analysis and Bootstrap method were used to test the mediating effect of acceptance of pain in catastrophic thinking and functional states.Results:The score of PCS was negatively correlated with the CPAQ⁃8 score,SF⁃12 physical health(PCS)score,and mental health(MCS)score.The score of CPAQ⁃8 was positively correlated with physical health(PCS)score and mental health(MCS)score.The regression analysis and Bootstrap test results showed that the direct effect of catastrophic thinking on physical function of patients was-0.27,95%CI(-0.49,-0.05).And the indirect effect mediated by pain acceptance was-0.16,95%CI(-0.29,-0.005).The direct effect of catastrophe thinking on the patient's psychological function was-0.32,95%CI(-0.47,-0.17).And the indirect effect mediated by pain acceptance was-0.16,95%CI(-0.28,-0.01).Conclusion:Pain acceptance plays a mediating role in the relationship between catastrophic thinking and functional status among patients with chronic degenerative low back pain.The mediating effect of pain acceptance should be stressed and corresponding measures should be implemented in order to improve the degree of pain acceptance of patients,thus improve their physical and psychological function.