The Role of Mediating the Relationship between Pain Anxiety and Psychosomatic Components on Quality of Life in Patients with Migraine Headache: Path Analysis

Authors

Abstract

Background: Migraine headaches are one of the psychosomatic disorders that severely impair patients' quality
of life and general functioning by mediating psychological problems. The aim of this study was to investigate
the mediating role of pain anxiety in the relationship between psychosomatic components on quality of life in
these patients.
Methods: In this cross-sectional study, using available sampling method, 250 patients with migraine were
selected based on inclusion and exclusion criteria among people with migraine referred to the Pain and
Neurology Clinic affiliated to Isfahan Medical Sciences, Isfahan, Iran, in year 2020. In the appropriate
psychological situation, after justifying the goals of the research, the World Health Organization Quality of Life
Questionnaire (WHOQOL-BREF), McCracken Pain Anxiety Questionnaire (PASS-20) and also the Diagnostic
Criteria for Psychosomatic Research Questionnaire (DCPR) were completed.
Findings: There was a negative correlation between the components of psychosomatic and pain anxiety with the
dimensions of quality of life. Moreover, there was an indirect relation between the components of psychosomatic
with the dimensions of quality of life, a direct relation between pain anxiety and the dimensions of quality of life.
Besides, the proposed model of path analysis of variables had a good fit.
Conclusion: The findings of this study explain the contribution of some underlying psychological factors in the
occurrence and persistence of headache. Moreover, this study suggests the development of psychological
intervention packages based on an explanatory model to improve the quality of life of patients with migraine.

Keywords


de Tommaso M, Federici A, Loiacono A, Delussi M, Todarello O. Personality profiles and coping styles in migraine patients with fibromyalgia comorbidity. Compr Psychiatry 2014; 55(1): 80-6.
Ryvlin P, Skorobogatykh K, Negro A, Sanchez-De La Rosa R, Israel-Willner H, Sundal C, et al. Current clinical practice in disabling and chronic migraine in the primary care setting: Results from the European My-LIFE anamnesis survey. BMC Neurol 2021; 21(1): 1.
Woldeamanuel YW, Cowan RP. Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci 2017; 372: 307-15.
Farhadi Z, Alidoost S, Behzadifar M, Mohammadibakhsh R, Khodadadi N, Sepehrian R, et al. The prevalence of migraine in Iran: A systematic review and meta-analysis. Iran Red Crescent Med J 2016; 18(10): e40061.
Koller LS, Diesner SC, Voitl P. Quality of life in children and adolescents with migraine: an Austrian monocentric, cross-sectional questionnaire study. BMC Pediatr 2019; 19(1): 164.
Nash JM, Williams DM, Nicholson R, Trask PC. The contribution of pain-related anxiety to disability from headache. J Behav Med 2006; 29(1): 61-7.
Rogers AH, Gallagher MW, Garey L, Ditre JW, Williams MW, Zvolensky MJ. Pain Anxiety Symptoms Scale-20: An empirical evaluation of measurement invariance across race/ethnicity, sex, and pain. Psychol Assess 2020; 32(9): 818-28.
Mortazavi-Nasiri FS, Pakdaman S, Dehghani M. The association of catastrophizing and pain-related anxiety with headache-related disability in patients suffering from migraine. Journal of Research in Behavioural Sciences 2015; 13(4): 609-16. [In Persian].
LaRowe LR, Powers JM, Garey L, Rogers AH, Zvolensky MJ, Ditre JW. Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain. Drug Alcohol Depend 2020; 214: 108171.
Swati T, Shipra S, Sanjay G. Role of Brimhana nasya in psychosomatic disorders. Int J Green Pharm 2018; 12(2): S301.
Porcelli P, Rafanelli C. Criteria for psychosomatic research (DCPR) in the medical setting. Curr Psychiatry Rep 2010; 12(3): 246-54.
Cosci F, Svicher A, Romanazzo S, Maggini L, De CF, Benemei S, et al. Criterion-related validity in a sample of migraine outpatients: The diagnostic criteria for psychosomatic research. CNS Spectr 2020; 25(4): 545-51.
Bagby RM, Parker JDA, Onno KA, Mortezaei A, Taylor GJ. Development and psychometric evaluation of an informant form of the 20-item Toronto alexithymia scale. J Psychosom Res 2021; 141: 110329.
Mattila AK, Kronholm E, Jula A, Salminen JK, Koivisto AM, Mielonen RL, et al. Alexithymia and somatization in general population. Psychosom Med 2008; 70(6): 716-22.
Provotorov VM, Kravchenko AI, Budnevskii AV, Alekhina OD, Grekova TI. Quality of life of patients in post-myocardial infarct period. Klin Med (Mosk) 1998; 76(11): 25-7. [In Russian].
Vieira RV, Vieira DC, Gomes WB, Gauer G. Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura. J Headache Pain 2013; 14: 18.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). 5th ed. Washington, DC: APA; 2013.
Fabbri S, Fava GA, Sirri L, Wise TN. Development of a new assessment strategy in psychosomatic medicine: The diagnostic criteria for psychosomatic research. Adv Psychosom Med 2007; 28: 1-20.
Bobevski I, Clarke DM, Meadows G. Health anxiety and its relationship to disability and service use: Findings from a large epidemiological survey. Psychosom Med 2016; 78(1): 13-25.
Fink P, Ornbol E, Christensen KS. The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLoS One 2010; 5(3): e9873.
Jeung DY, Lee HO, Chung WG, Yoon JH, Koh SB, Back CY, et al. Association of emotional labor, self-efficacy, and type A personality with burnout in Korean dental hygienists. J Korean Med Sci 2017; 32(9): 1423-30.
Lohse T, Rohrmann S, Richard A, Bopp M, Faeh D. Type A personality and mortality: Competitiveness but not speed is associated with increased risk. Atherosclerosis 2017; 262: 19-24.
Lewis TT, Everson-Rose SA, Karavolos K, Janssen I, Wesley D, Powell LH. Hostility is associated with visceral, but not subcutaneous, fat in middle-aged African American and white women. Psychosom Med 2009; 71(7): 733-40.
Fava GA, Cosci F, Sonino N. Current psychosomatic practice. Psychother Psychosom 2017; 86(1): 13-30.
Leibenluft E, Stoddard J. The developmental psychopathology of irritability. Dev Psychopathol 2013; 25(4 Pt 2): 1473-87.
Campos-Fernandez D, Fonseca E, Olive-Gadea M, Quintana M, Abraira L, Seijo-Raposo I, et al. The mediating role of epileptic seizures, irritability, and depression on quality of life in people with epilepsy. Epilepsy Behav 2020; 113: 107511.
McCracken LM, MacKichan F, Eccleston C. Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: Effectiveness and clinically significant change. Eur J Pain 2007; 11(3): 314-22.
Davoodi I, Zargar Y, mozafari Pour E, Nargesi F, Mola K. The relationship between pain catastrophizing, social support, pain-related anxiety, coping strategies and neuroticism, with functional disability in rheumatic patients. Journal of Health Psychology 2012; 1(1): 54-67. [In Persian].
Nejat S, Montazeri A, Naieni K, Mohammad K, Majdzadeh R. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. J Sch Public Health Inst Public Health Res 2006; 4(4): 1-12. [In Persian].
Galeazzi GM, Ferrari S, Mackinnon A, Rigatelli M. Interrater reliability, prevalence, and relation to ICD-10 diagnoses of the Diagnostic Criteria for Psychosomatic Research in consultation-liaison psychiatry patients. Psychosomatics 2004; 45(5): 386-93.
Goli F, Roohafza H, Khani A, Afshar H. Validation of self-assessed form of diagnostic criteria for psychosomatic research adapted from diagnostic criteria for psychosomatic research - structured interview. J Res Med Sci 2022; 27: 1.
von Rimscha S, Moergeli H, Weidt S, Straumann D, Hegemann S, Rufer M. Alexithymia and health-related quality of life in patients with dizziness. Psychopathology 2013; 46(6): 377-83.
Lane RD. Alexithymia 3.0: Reimagining alexithymia from a medical perspective. BioPsychoSocial Med 2020; 14(1): 21.
Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V, Stojanov A. Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19. Int J Soc Psychiatry 2021; 67(2): 175-81.
Ghadimi Karahroudi S, Sepehrian Azar F. Comparison of health anxiety, sleep and life quality in people with and without chronic pain. J Anesth Pain 2020; 10(4): 63-76. [In Persian].
Grassi L, Rossi E, Sabato S, Cruciani G, Zambelli M. Diagnostic criteria for psychosomatic research and psychosocial variables in breast cancer patients. Psychosomatics 2004; 45(6): 483-91.
Sharifirad G, Bahari A, Bazani M, Jalilian M. Relationship between aggression and demographic characteristics in male high school students of Ilam. Zanko Journal of Medical Sciences 2016; 16(51): 36-44. [In Persian].
Lemogne C, Turinici M, Panjo H, Ngo C, Canoui-Poitrine F, Chauvet-Gelinier JC, et al. Personality and breast cancer screening in women of the GAZEL cohort study. Cancer Med 2018; 7(2): 515-24.
Pollock BD, Chen W, Harville EW, Bazzano LA. Associations between hunter type A/B personality and cardiovascular risk factors from adolescence through young adulthood. Int J Behav Med 2017; 24(4): 593-601.
Shah SIA, Sikandar MZ, Haq I. Personality traits, anxiety and depression in post-myocardial infarction patients. PJMHS 2020; 14(3): 706-10.
Milicic D, Brajkovic L, Macek JL, Andric A, Ardalic Z, Buratovic T, et al. Type a personality, stress, anxiety and health locus of control in patients with acute myocardial infarction. Psychiatr Danub 2016; 28(4): 409-14.
Korotkov D, Perunovic M, Claybourn M, Fraser I, Houlihan M, Macdonald M, et al. The type B behavior pattern as a moderating variable of the relationship between stressor chronicity and health behavior. J Health Psychol 2011; 16(3): 397-409.
Dincer B, Yildirim AE, Oguz A. Changes in sexual functions and alexithymia levels of patients with type 2 diabetes during the COVID-19 pandemic. Sex Disabil 2021; 1-18.
Nekouei ZK, Doost HT, Yousefy A, Manshaee G, Sadeghei M. The relationship of Alexithymia with anxiety-depression-stress, quality of life, and social support in Coronary Heart Disease (A psychological model). J Educ Health Promot 2014; 3: 68.
Kehler MD, Hadjistavropoulos HD. Is health anxiety a significant problem for individuals with multiple sclerosis? J Behav Med 2009; 32(2): 150-61.
Ottolini F, Modena MG, Rigatelli M. Prodromal symptoms in myocardial infarction. Psychother Psychosom 2005; 74(5): 323-7.
Rong Q, Xu L, Tian F, Wang H. Survey of personality traits, anxiety and depression in patients with leukemia. J Leuk Lymphoma 2017; (12): 349-52.
Carleton RN, Abrams MP, Asmundson GJ, Antony MM, McCabe RE. Pain-related anxiety and anxiety sensitivity across anxiety and depressive disorders. J Anxiety Disord 2009; 23(6): 791-8.