پیش بینی فاجعه سازی درد با ذهن آگاهی پایین در مدل ترس اجتنابی از درد مزمن

The relationship between persistent pain and self-directed, non-reactive awareness of present-moment experience (i.e., mindfulness) was explored in one of the dominant psychological theories of chronic pain – the fear-avoidance model [53]. A heterogeneous sample of 104 chronic pain outpatients at a multidisciplinary pain clinic in Australia completed psychometrically sound self-report measures of major variables in this model: Pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability. Two measures of mindfulness were also used, the Mindful Attention Awareness Scale [4] and the Five-Factor Mindfulness Questionnaire [1]. Results showed that mindfulness significantly negatively predicts each of these variables, accounting for 17–41% of their variance. Hierarchical multiple regression analysis showed that mindfulness uniquely predicts pain catastrophizing when other variables are controlled, and moderates the relationship between pain intensity and pain catastrophizing. This is the first clear evidence substantiating the strong link between mindfulness and pain catastrophizing, and suggests mindfulness might be added to the fear-avoidance model. Implications for the clinical use of mindfulness in screening and intervention are discussed.

Psychological models of chronic pain, such as the well-supported fear-avoidance model, show that the way people interpret and respond to their pain sensations is a strong determinant of their future pain experience [20] and [53]. Cognitions shape not only psychological outcomes such as emotional functioning, but the nervous system activity underlying pain perception [39] and [51]. It is therefore unsurprising that maladaptive pain cognitions, such as pain catastrophizing, are associated with emotional and behavioural responses (e.g., fear and avoidance) that predict depression, functional disability and future pain [26]. Catastrophizing is a central variable in the fear-avoidance (FA) model (see Fig. 1), not only because it is understood as the cognitive route through which fear of pain develops [52], but because this negative evaluation of pain accounts for 7–31% of the variance in pain severity [44]. This suggests that addressing the cognitive distortions that occur through pain catastrophizing may be beneficial in interrupting the fear-avoidance cycle. Cognitive-behavioural therapy (CBT) for chronic pain has emerged as one approach to challenging these unhelpful cognitions [56]. Another promising approach is the use of so-called ‘third wave’ psychological models. These are distinct from ‘second wave’ cognitive behavioural approaches in that they address metacognitive variables such as mindfulness, and focus on acceptance of inner experiences, such as thoughts, rather than changing them.