الگوی ساختاری روابط بین عوامل آسیب‌زای درد، فاجعه‌آفرینی، ترس و سازگاری با درد در بیماران مبتلا به دردهای مزمن عضلانی- اسکلتی

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه روان‌شناسی، دانشکده‌ی ادبیات، ‌دانشگاه لرستان، خرم‌آباد، ایران

2 دانشجوی دکتری، گروه روان‌شناسی، دانشکده‌ی ادبیات، دانشگاه لرستان، خرم‌آباد، ایران

چکیده

مقدمه: امروزه، بهترین مدل ارزیابی و درمان درد مزمن عضلانی- اسکلتی، مدل ترس- اجتناب است که نقش عوامل آسیب‌زای درد (روان‌رنجوری، اجتناب تجربی و عواطف منفی) در آن به خوبی مشخص نشده است. هدف از انجام مطالعه‌ی حاضر، بررسی الگوی ساختاری روابط بین عوامل آسیب‌زای درد، فاجعه‌آفرینی، ترس از درد و سازگاری با درد (شدت و ناتوانی درد) در چارچوب مدل ترس- اجتناب بود.روش‌ها: 314 بیمار مبتلا به دردهای مزمن عضلانی- اسکلتی به روش نمونه‌گیری در دسترس از بیمارستان‌ها و مطب‌های خصوصی شهر اصفهان در سال 1394 انتخاب شدند. این افراد، با پاسخ دادن به شش پرسش‌نامه‌ی تجدید نظر شده‌ی پنج عاملی NEO (NEO-five factor inventory) فهرست عواطف مثبت و منفی (Positive and ngative affect schedule یا PANAS)، پرسش‌نامه‌ی پذیرش و عمل (Acceptance and action questionnaire)، مقیاس فاجعه‌آفرینی درد (Pain catastrophizing scale)، مقیاس ترس از حرکت تمپا (Tampa scale kinesiophobia یا TSK)، و پرسش‌نامه‌ی درجه‌بندی درد مزمن (Graded chronic pain scale) در پژوهش شرکت کردند. برای تحلیل داده‌ها از آزمون مدل‌سازی معادلات ساختاری استفاده شد.یافته‌ها: عوامل آسیب‌زای درد بر فاجعه‌آفرینی و فاجعه‌آفرینی بر ترس از درد و ترس از درد بر سازگاری درد اثر مستقیم و معنی‌داری داشت (001/0 > P برای همه‌ی موارد). همچنین، فاجعه‌آفرینی از طریق عوامل آسیب‌زای درد و ترس از درد از طریق فاجعه‌آفرینی درد با سازگاری درد به طور غیر مستقیم ارتباط معنی‌داری داشتند؛ در حالی که رابطه‌ی مستقیم عوامل آسیب‌زای درد و سازگاری درد تأیید نشد.نتیجه‌گیری: عوامل آسیب‌زای درد، توان پیش‌بینی‌ سازگاری درد را در چارچوب مدل ترس- اجتناب دارد. با کاهش عوامل آسیب‌زای درد، می‌توان شدت و ناتوانی درد بیماران مبتلا به اختلالات عضلانی- اسکلتی را کاهش داد.

کلیدواژه‌ها

عنوان مقاله [English]

The Structural Model of Relationships between Pain Vulnerability, Catastrophizing, Fear and Pain Adjustment in Patients with Chronic Musculoskeletal Pain

نویسندگان [English]

  • Fazlolah Mirdrikvand 1
  • Alireza Shirazitehrani 2
  • Mohammad Ali Sepahvandi 1
1 Assistant Professor, Department of Psychology,School of Literature, Lorestan University, Khorramabad, Iran
2 PhD Student, Department of Psychology, School of Literature, Lorestan University, Khorramabad, Iran
چکیده [English]

Background: Nowadays, fear-avoidance model is the best model for the assessment and treatment of chronic musculoskeletal pain in which, the role of the pain vulnerability (neuroticism, experiential avoidance and negative affect) is not well defined. The purpose of present study was to evaluate the structural pattern of the relationships between the pain vulnerability, catastrophizing, fear of pain and pain adjustment (pain intensity and inability) in the framework fear-avoidance model.Methods: Patients with chronic musculoskeletal pain were selected from hospitals and private clinics in Isfahan city, Iran, during 2015 using convenience sampling method. They participated in the research by filling out six questionnaires: NEO Five-Factor Inventory (NEO-FFI), Positive and Negative Affect Schedule (PANAS), Acceptance and Action Questionnaire (AAQ), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia (TSK) and Graded Chronic Pain Scale (GCP). Data were analyzed using structural equation modeling method.Findings: Pain vulnerability had significant direct effects on catastrophizing and catastrophizing on fear of pain and fear of pain on pain adjustment (P < 0.001 for all). In addition, catastrophizing through pain vulnerability and fear of paintrough catastrophizing had indirect effects on pain adjustment; while the direct relationship between vulnerability and pain adjustment was not confirmed.Conclusion: The results of this research showed that pain vulnerability could predict pain adjustment in the framework fear-avoidance model. Therefore, reducing pain vulnerability can reduce pain intensity and inability in patients with chronic musculoskeletal pain.

کلیدواژه‌ها [English]

  • Pain vulnerability
  • Catastrophizing
  • Fear of pain
  • Pain adjustment
  • Chronic musculoskeletal pain

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مجله دانشکده پزشکی اصفهان
دوره 34، شماره 413 - شماره پیاپی 413
بهمن و اسفند 1395
صفحه 1595-1606

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سابقه مقاله

  • تاریخ دریافت: 29 آبان 1395
  • تاریخ بازنگری: 07 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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