نوع مقاله : مقاله پژوهشی

نویسنده

عضو هیئت علمی گروه روانشناسی دانشگاه شهید چمران اهواز،اهواز ، ایران

10.22055/psy.1999.16438

چکیده

   اصطلاح‌ درد مزمن‌ معمولاً برای‌ توصیف‌ دردی‌ غیرسرطانی‌ و مقاوم‌ به‌ درمان‌ به‌ کار می‌رود که‌ علی‌رغم‌ درمانهای‌ انجام‌ شده‌ بیش‌ از شش‌ ماه‌ تداوم‌ یافته‌ است‌.
دردهای‌ مزمن‌ برای‌ بسیاری‌ از بیماران‌ مشکلاتی‌ ایجاد می‌کند که‌ از میان‌ آنها می‌توان‌ افسردگی‌، اضطراب‌، کاهش‌ کار و فعالیتهای‌ روزمره‌، ناتوانی‌ جسمانی‌ و مراجعه‌ مکرر به‌ مراکز درمانی‌ را ذکر کرد. اما بررسیهای‌ انجام‌ شده‌ نشان‌ داده‌ است‌ که‌ همه‌ افراد دارای‌ درد مزمن‌ به‌ این‌ گونه‌ مشکلات‌ مبتلا نیستند. با توجه‌ به‌ اینکه‌ درد مزمن‌ همواره‌ با اختلال‌ در سازگاری‌ همراه‌ نیست‌ تعیین‌ عوامل‌ مؤثر بر میزان‌ سازگاری‌ با درد می‌تواند امکان‌ طراحی‌ روشهای‌ کارآمدی‌ را فراهم‌ آورد تا به‌ کمک‌ آنها بتوان‌ به‌ افرادی‌ که‌ دارای‌ سازگاری‌ نامطلوبی‌ با درد مزمن‌ هستند و یا در معرض‌ خطر ناسازگاری‌ هژستند کمک‌ کرد.
در پژوهش‌ حاضر 145 بیمار دارای‌ درد مزمن‌ به‌ مدت‌ 9 ماه‌ مورد مطالعه‌ قرار گرفتند. در ابتدای‌ مطالعه‌ (خط‌ پایه‌) متغیرهای‌ روان‌ نژندگرایی‌، شدت‌ درد، خودکفایی‌ مربوط‌ به‌ درد، میزان‌ کنترل‌ بر درد، باور به‌ پایداری‌ درد و راهبرد مقابله‌ای‌ فاجعه‌ آفرینی‌ به‌ عنوان‌ متغیرهای‌ پیش‌ بینی‌ کننده‌ سازگاری‌ با درد و افسردگی‌، ناتوانی‌ جسمانی‌، رفتارهای‌ شکایت‌ از درد و میزان‌ مصرف‌ دارو به‌ عنوان‌ متغیرهای‌ ارزیابی‌ کننده‌ میزان‌ سازگاری‌ با درد مورد سنجش‌ قرار گرفتند. متغیرهای‌ اخیر به‌ مدت‌ 9 ماه‌، هر سه‌ ماه‌ یکبار، اندازه‌گیری‌ شدند.
داده‌های‌ مطالعه‌ با استفاده‌ از روش‌ تحلیل‌ رگرسیون‌ چند متغیری‌ سلسله‌ مراتبی‌ مورد بررسی‌ قرار گرفتند. نتایج‌ این‌ تحلیلها نشان‌ داد که‌ پس‌ از کنترل‌ اثرات‌ سن‌، جنسیت‌، سابقه‌ درد و شدت‌ درد، روان‌نژندگرایی‌ می‌تواند شدت‌ افسردگی‌ و شکایت‌ از درد را در طول‌ 9 ماه‌ پیش‌بینی‌ کند. پس‌ از کنترل‌ اثر روان‌نژندگرایی‌، بیمارانی‌ که‌ در ابتدای‌ مطالعه‌ میزان‌ خودکفایی‌ بالاتری‌ را در مورد درد خود گزارش‌ کرده‌ بودند در طول‌ مطالعه‌ افسردگی‌، ناتوانی‌ جسمانی‌ و رفتارهای‌ شکایت‌ از درد کمتری‌ را گزارش‌ کرده‌ بودند. آن‌ گروه‌ از بیمارانی‌ که‌ در ابتدای‌ مطالعه‌ از راهبرد مقابله‌ای‌ فاجعه‌آفرینی‌ به‌ هنگام‌ مواجهه‌ با درد بیشتر استفاده‌ می‌کردند در فاصله‌ 3 ماه‌ پس‌ از آغاز مطالعه‌ افسردگی‌ شدیدتری‌ را گزارش‌ کردند. بالاخره‌ بیمارانی‌ که‌ در ابتدای‌ مطالعه‌ میزان‌ کنترل‌ بیشتری‌ را بر درد خود گزارش‌ کرده‌ بودند در فاصله‌ 3 ماه‌ و 6 ماه‌ از آغاز مطالعه‌ مصرف‌ داروی‌ کمتری‌ را گزارش‌ کرده‌ بودند. در این‌ نوشتار یافته‌های‌ فوق‌ و کاربردهای‌ بالینی‌ احتمالی‌ آنها مورد بررسی‌ قرار خواهند گرفت‌.

کلیدواژه‌ها

عنوان مقاله [English]

The Cross-sectional and Longitudinal Effects of the Personality Dimension of Neuroticism and Pain- Related Beliefs/Coping Strategies on Depression, Physical Disability, Complaint Behaviours and Medication Consumption.

نویسنده [English]

  • M.A. Asgharimoghaddam

Faculty member of Psychology Department, Shahid Chamran University, Ahvaz, Ahvaz, Iran

چکیده [English]

The present study examined the cross-sectional and longitudinal effects of the personality dimension of neuroticism and pain-related beliefs/coping strategies on depression, physical disability, complaint behaviours and medication consumption in 145 heterogenous chronic pain patients over a 9-month period. The results were analysed using a series of multiple hierarchical regression analyses which incorporate an attempt to achieve a balance for Type I and Type II errors. All of these analyses were controlled for age, gender, pain duration and pain intensity. The results indicated that the baseline measure of neuroticism was predictive of depression and complaint hehaviour nine months after the initial assessment. After controlling for the effects of neuroticism, the baseline measure of pain self-efficacy beliefs were predictive of depression, physical disability and complaint behaviour nine months after the initial assessment, After controlling for the effects of neuroticism, pain self-efficacy heliefs pain control appraisals and pain stability, the results of the study also support a link between the baseline measure of catastrophising and scores of depression as repoted at the baseline of the study and three months after the initial assessment. Finally, those patients who perceived higher levels of control over the pain at the baseline of the study reported less use of pain-related medication at the 6-month follow-up period. The potential signficance of these findings for identifying patients at risk of poor adjustment to chroi1c pain is discussed.

Affleck, G., Tennen, H., Urrows, S., & Higgins, P. (1992a). Neuroticism and the pain-mood relation in rheumatoid arthritis: Insight from a prospective daily study. Journal of consulting and Clinical Psychology, 60, 119-126
Affleck, G., Urrows, S., Tennen, H., & Higgins, P. (1992b). Daily coping with pain from rheumatoid arthritis: Patterns and correlates. Pain, 5!, 221-229.
Anderson, G.B.J. (1981). Epidemiological aspects on low-back pain in industry. Spine, 6, 53-60.
Aronoff, G.M., & McAlary, P.W. (1990). Multidiciplinary treatment of intractable pain syndromes. In S. Lipton, E. Tunics, & M. Zoppi(eds.), Advances in Pain Research and Therapy (Vol,13)(pp. 267-276). New York:Raven Press.
Asghari, A & Nicholas, M.K.(1996). “Chronic pain, puin-related beliefs/coping strategies, personality, and pain adjustment. A causal analysis”. Paper presented at the 17th Annual Scientific Meeting of the Australian Pain Society. Canberra.
Australian Institute of Health and Welfare. The Third Biennial Report of the Australian Institute of Health and Welfare. Canberra: Australian Government Publishing service.
Bandura, A. (1977). Social Learning Theory. New Jersey:Prentice-Hall.
Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G.(1979). Cognitive Therapy of Depression. New York: Guilford Press.
Beers, T.M., & Karoly.P.(1979). Cognitive strategies, expectancies and coping style in control of pain. Journal of Consulting and Clinical Psychology, 47,
179-180.
Bird, K., & Hall, W. (1986). Psychiatric research: statistical power in psychiatric research. Australian and New Zealand Journal of psychiatry, 20,
189-200.
Black, R.G.(1975). The chronic pain syndrome. Surgical Clinics of North America, 55,999-1011.
Bonica, J.J.(1977). Neurophysiologic and pathophysiologic aspects of acute and chronic pain. Archives of Surgeiy, 112, 750-761.
Bowsher, D., Rigge, M., & Sopp, L. (1991). Preválance of chronic pain in the British poulation: A telephone survey of 1937 househols, Pain Clinic,
4,223-230.
Brattberg, G., Thorshund, M., & Wikman, A. (1989). The prevalence of pain in a general population: The results of postal survey in a county of Sweden. Pain, 37, 215-222.
Brown, G.K., & Nicassio, P.M. (1987). Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients. Pain, 31, 53-64.
Clark, M., Gosnell, M., & Shapiro, D. (1977). The new war on pain. Newsweek (April 25), 89, 48-58.
Costa, P.T., & McCrae, R.R. (1980). Influences of extraversion and neuroticism on:ubjective well-being: happy and unhappy people. Journal of Personality and Social Psychology, 38, 668-678.
Costa, P.T., & McCrae, R.R. (1985). The NEO Personality Invenloiy Manual.
Odessa: Psychological Assessment Resources.
Costa, P.T., & McCrae, R.R. (1987). Neuroticism, somatic complaint and disease: Is the bark worse than the bite. Journal of Personality, 55, 299-3 16.
Costa, P.T., & McCrae, R.R. (1992). Revised NEO Personality Inventory (NEO PI-R) and NEO Five-Factor Inventory (NEO-FFI). Odessa: Psychological Assessment Resources.
Cousins, M.J. (1995). Back pain in work place. In: W.E. Fordyce (Ed.), Task Force on Pain in Work Place (P.5). Seattel: I.ASP Press.
Crook, J., Rideout, E., & Browne, G.(1984). The prevalence of pain complaints in a general population. Pain, 18, 299-314.
Deyo, R.A. (1986). Comparative validity of the Sickness Impact Profile and shorter scales for functional assessment in low back pain. Spine, 11,
951-954.
Doan, B.D., & Wadden, N.P. (1989). Relationships between depression symptoms and descriptions of chronic pain. Pain, 36, 75-84.
Doloe, J.J. (1987). Self-efficacy and disability beliefs in behavioural treatment of pain. Behaviour Research and Therapy, 25, 289-299.
Engel, G.L.(1959). “Psychogenic pain” and the pain prone patient. American Journal of Medicine, 26, 899-918.
Eysenck, H.J. & Eysenck, S.B.G. (1986). Manual of the Eysenck Personality Questionnaire (Jounior & Adult) (3rd ed). Sevenoaks, Kent: Hodder & Stoughton.
Fehr, T. (1977). A longitudinal study of the effect of the transcew”ntal meditation program on chnges in personality. In D. Orne-Johnson & J. Farrow. (eds.), Scientific Research on the Transcendental Meditation Program. Collected Papers (pp. 520-523). New York: Merupress.
Follick, M.J., Smith, T.W., & Ahren, D.K.(1985). The Sickness Impact Profile:
A global measure of disabitity in chronic low hack pain. Pain, 21, 67-76.
Fordyce, W.E., Brena, S.F., Holcomb, R.J., Delateur, B.J., & Loeser, J.D. (1978). Relationship of patients semantic pain descriptions to physician diagnostic Judgement, activity level measures and MMPI. Pain, 5, 293-303.
Frymoyer, J.W. (1988). Back pain and sciatica. New Engliind Journal of Medicine, 318, 291-300.
Gamsa, A. (1990). Is emotional disturbance a precipitator or a consequence of chronic pain’? Pain, 42, 183-195.
Gamsa, A. (1994). The role of psycholigical factors in chronic pain: 1 A half century of study. Pain, 57, 5-11.
Gil, K.M., Abrams, M.R., Philips, G., & Keefe, F.J. (1989). Sickle cell disease pain. The relation of pain coping strategies of adjustment. Journal of consulting and Clinical Pycholo’, 57, 725-731.
Gordon, A., & Hitchcock, E.R. (1983). Illness behaviour and personality in intractable facial pain syndromes. Pain, 17, 267-276.
Gross, P.(1986). The economic costs of chronic pain in Australia. Paper presented at the 8th Australian ScientitIc Meeting of Australian Pain Society. Melbourne, Australia.
Harkins, S.W., Price, D.D., & Braith, J. (1989). Effects of exrtraversion and neurolicism on experimental pain, clinical pain, and illness behaviour. Pain, 36, 209-218.
Haynes, R.B., & Dantes, R. (1987). Patients compliance and the conduct and interpretation of therapeutic trials, consulting Clinical Trials, 8, 12-19.
Hill, A. (1993). The use of pain coping strategies by patients with phantom limb pain. Pain, 55, 347-353.
Jensen, M.P., & Karoly, P. (1991). Control beliefs, coping efforts, and adjustment to chronic pain. Journal of Consulting and Clinical Psychology,
59,
432-438.
Jensen, M.P., & Karoly, P. (1992). Self-report scales and procedures for assessing pain in adulus. In D.C. Turk & R. Meizack (Eds.), Handbook of Pain Assessment (pp. 193-213). New York: Guilford Press.
Jensen, M.P. Turner, J.A., Romano, J.M., & Karoly, P. (1991a). Coping with chronic pain: A critical review of the literature. Pain, 47, 249-283.
Jensen, M.P., Turner, J.A., & Romano, J.M. (1991b). Self-efficacy and outcome expectancy relationship to chromic pain, coping strategies and adjustment. Pain, 44, 263-269.
Jensen, M.P., Turner, J.A., Romano, J.M., & Lawler, B.K. (1994). Relationship of pain-specific beliefs to chronic pain adjustment. Pain, 57, 301-309.
Jorm, A.F. (1989). Modifiability of trait anxiety and neuroticism: A meta-analysis of the literature. Australian and New Zealand Journal of Psychiatiy, 23, 21-29.
Keefe, F.J., Dunsmore, J., & Burnett, R. (1992a). Behavioural and congnitive behavioural approaches to chronic pain: Recent advance and future direction. Journal of Consulting and Clinical Psychology, 60, 528-536.
Keefe, F.J., Salley, A.N., & Lefebre, J.C.(1992b). Coping with pain: conceptual concern and future directions. Pain, 51, 131-134.
Keefe, F.J., & Williams, D.A. (1990). A comparison of coping strategies in chronic pain patients. in different age groups. Journal of Gerontology, 45,
161-165.
Larsen, R.J., & Ketelaar, T. (1991). Personality and susceptibility to positive and negative emotional states. Jamal of Personality and Social Psychology,
61, 132-140.
Linton, S.J. (Fall 1994). Chronic back pain: Integrating psychological and physical therapyan overview. Behavioral medicine, 20, 101-104.
Love, A.W. (1987). Depression in chronic low back patients: Diagnostic efficacy of three self-report questionnaires. Journal of Clinical Psychology,
43, 84-89.
Love, A.W., & Peck, C.L.(1987). The MMPJ and Psychological factors in chronic low back pain: A review. Pain, 28, 1-12. -
Magni, G., Caldieron, C., Rigatti-Luchini, S., & Merskey, H. (1990). Chronic musculoskeletal pain and depression symptoms in the general population:
An analysis of the 1st National Health and Nutrition Examination Survey data Pain, 43, 299-307.
Magni, G., Marchetti, M., Moreschi, C., Merskey, H., & Rigatti-Luchjnj, S. (1993). Chronic musculoskeletal pain and depression symptoms in the National Health and Nutrition Examination. 1: Epidemiological follow-up study. Pain, 53, 163-168.
Main, C.J. & Waddell, G.(1991). A comparison of cognitive, measures in low back pain: Statistical structure and clinical validity at initial assessment Pain, 46, 287-298.
McCray, R.R. & Costa, P.T.(1991). Adding Liebe and Arbeit: The Full-Five Factor Model and well-being. Personality and Social Psychology Bulletin, 17,
227-232. -
Nachemson, A.L.(1992). Newest knowledge of low back pain. Clinical Orllzopaedics and Related Research, 279, 8-20.
Nicholas, M.K. (1989). Self-efficacy and chronic pain. Paper Presented at the annual conference of the British Psychological Society, St, Andrews.
Nicholas, M.K., Wilson, P.H. & Goyen, J.(1992). Comparison of cognitivebehavioural group treatment and an alternative, non-psychological treatment for chronic low back pain patients. Pain,
48,339-347.
Nicholas, M.K., Blanck, A., & Cohen, M.C. (1996). Comparison of three groups of injured workers with d[ferent outcomes at 2-4 years post injuly. Paper presented at the 17th Australian Scientific Meeting of Australian Pain Society. Canberra, Australia.
Parker, J.C., Smarr, KL., Buescher, K.L., Philips, L.R., Frand, R.G., Beck, N.C., Anderson, S.K., & Walker, S.E. (1989). Pain control and rational thinking: Implications for rheumatiod arthritis. Arthritis and Rheumatism, 32, 984-990.
Philips, H.C., & Jahanshahi, M.(1986). The components of pain behaviour report. Behaviour Researh and Therapy, 24, 117-125.
Pither, C.E., & Nicholas, M.K.(1991). The identification of iatrogenic factors in the development of chronic pain syndrome: abnormal treatment behaviour? In M.R. Bond, J.E. Chariton, & C.J. Woolf(Eds.), Proceeding of the 1-7th World Congress on Pain(pp. 429-434). Amsterdam: Elsevier.
Riley, J.F., Ahern, D.K., & Follick, M.J.(1988). Chronic pain and functional impairment: Assessing beliefs about their relationship. Archives of Physical Medicine and Rehabilitation, 59, 579-582.
Roland, M., & Morris, R.(1983). A study of a natural history of the back pain, part 1: Development of a reliable and sensitive measure of disability in low back pain. Spine, 8, 141-144.
Romano, J.M., & Turner, J.A.(1985). Chronic pain and depression: Does the evidence support a relationship? Rcychological Bulletin, 97, 18-34.
Roome, P., & Humphrey, M.(1992). Personality factors in analgesic usage, Stress Medicine, 8,237-240.
Rosenstiel, A.K., & Keefe, F.J.(1983). The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain, 17,33-44.
Roy, R.(1985). Engel’s pain-prone disorder patients: 25 years after. Psychotherapy and Psychosomatic, 43, 126-135.
Rudy, T.E., Kems, R.D., & Turk, D.C.(1988). Chronic pain and depression:
Toward a cognitive-behavioural mediation model. Pain, 35, 129-140.
Spanswick, C.C., & Main, C.J.(1989). The role of the anaesthetist in the management of chronic low back pain. In M. Roland & J.R. Jenner (Eds.), Back Pain: New Approaches to Education and Rehabilitation (pp. 108-128).
Manchester: Manchester University Press.
Spence, S.H.(1993). Role of cognitive therapy in the management of chronic pain. Behaviour Change, 10, 228-236.
Taylor, H., & Curran, N.M.(1985). The Nuprin Pain Report. New York: Louis Harris.
The Report of the’ Commission on Evaluation qf pain. (1986). United Stated Department of Health and Human Scrviccs(SSATUB) 64-031.
Washington, DC: Government Printing Office.
Turk, D.C. (1996). Biopsychosocial perspective on chronic pain, In R.J Catchel & D.C. Turk (Eds.), Psychological Approaches to Pain Management (pp.3-32). New York: Guilford Press.
Turk, D.C., Okifuji, A., & Scharff, L.(1995). Chronic pain and depression:
Role of perceived impact and perceived control in different age cohorts. Pain, 61, 93-101.
Turner, J.A. (1991). Coping and chronic pain. In M.R. Bond, J.E. Chariton, & C.J.Woolf(eds.), Proceedings of the VIth World Congress on Pain (pp. 219-227). Amsterdam: Elsevier.
Turner, J.A. Calsyn, D.A, Fordyce, W.E., & Ready, L.B.(1982). Drug utilisation patterns in chronic pain patients. Pain, 12, 357-363.
Turner, J.A., & Romano, J.M.(1984), Self-report screening measures for depression in chronic pain patients. Journal of Clinical Psychok,gj, 40,
909-913.
Wade, J.B., Doughery, L.M., Hart, RP., Rafii, A., & Price, D.D.(1992a). A canonical correlation analysis of the influence of neuroticism and extraversion on chronic pain, suffering and pain behaviour. Pain, 51, 67-73.
Westrin, C., Hirsch, C., & Lindegard, B.(1972). The personality of the back patient. Clinical Orthopaedics and Related Research, 87, 209-216.
Williams, D.A., & Keefe, F.J.(1991). Pain beIie1 and the use of cognitive-behavioural coping strategies. Pain, 46, 185-190.
Williams, D.A., & Thorn, B.C(1989). An empirical assessment of pain beliefs. Pain, 36, 351-358.
Woodforde, J., & Merskey, H.(1972). Personality traits of patients with chronic pain. Journal of Psychosomatic Research, 16, 167-172.
Zarkowska, A.W.(1981). The relationship between subjective and behavioural aspects in people suffering from lower hack pain. M.Phil. Thesis. University of London.