Pain Catastrophizing in Patients with Noncardiac Chest Pain: Relationships With Pain, Anxiety, and Disability
| Autor: | Rebecca A. Shelby, Indira Varia, Daphne C. McKee, Susan G. Silva, Yelena B. Riordan, Michael A. Blazing, Paige Johnson, Francis J. Keefe, Sandra J. Waters, Verena Knowles, James A. Blumenthal, Tamara J. Somers, Lilin She |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Chest Pain medicine.medical_specialty Physical disability Personality Inventory media_common.quotation_subject Anxiety Models Psychological Chest pain Severity of Illness Index Article Specific phobia Disability Evaluation Cost of Illness Sickness Impact Profile Surveys and Questionnaires Activities of Daily Living Adaptation Psychological medicine Humans Psychiatry Applied Psychology Aged media_common Panic disorder Middle Aged medicine.disease Psychiatry and Mental health Linear Models Female Pain catastrophizing medicine.symptom Worry Psychology Attitude to Health Social Adjustment Anxiety disorder Clinical psychology |
| Zdroj: | Psychosomatic Medicine. 71:861-868 |
| ISSN: | 0033-3174 |
| Popis: | Chest pain is one of the most frequent complaints seen in primary medical care settings and annually, more than six million patients with chest pain are admitted to hospitals in the U.S. (1). Over 50% of patients presenting with chest pain do not have identifiable cardiac ischemia or other major physical disorders that account for their symptoms (2–5). Chest pain with no evidence of underlying cardiac disease is known as non-cardiac chest pain (NCCP; 6). Despite having a good medical prognosis (7,8), many NCCP patients experience significant limitations in activity, reductions in quality of life, increased psychosocial disability, occupational impairment, and high levels of medical utilization related to chest pain (8–14). Following medical evaluations with negative or normal cardiac test results, many patients continue to experience chest pain and significant impairments in daily functioning (9,15). Two studies followed NCCP patients for five years and found that symptoms, impaired functioning, and over utilization of medical care persisted in the majority of patients (16,17). Studies suggest that psychiatric disorders, particularly anxiety disorders, are prevalent in patients with NCCP (18–22), and many NCCP patients who do not meet criteria for a psychiatric diagnosis experience subclinical symptoms that contribute to impairment (3). The rates of current and lifetime anxiety disorders in NCCP patients are higher than reported rates in patients with established coronary heart disease (23). A recent study using structured diagnostic interviews reported that 75% of NCCP patients met criteria for a current anxiety disorder or a subclinical anxiety disorder, and 55% met criteria for a lifetime history of an anxiety disorder (12). In contrast, a recent study among patients with established coronary heart disease reported that 36% met criteria for a current anxiety disorder and 45% met criteria for a lifetime history of an anxiety disorder (23). Other studies in patients with established coronary heart disease have focused on specific anxiety disorders such as panic disorder (estimates 0–29%), social phobia (estimates 5–21%), and specific phobia (estimates 1–15%) (24–27). Data show that NCCP patients with an anxiety disorder have more severe and frequent chest pain, more life interference due to pain, more affective distress related to pain, and higher rates of healthcare utilization compared to patients with no psychiatric diagnosis (12). In NCCP patients, anxiety has been related to bodily monitoring which can perpetuate worry about illness (14), disease-related fear (28), poorer coping strategies (17) and lower levels of reported emotional support (14). Moreover, patients who are anxious about their unexplained chest pain often stay active in the healthcare system resulting in more substantial economic burden (29). There is limited information about the relationship between the presence of an anxiety disorder and healthcare use in patients with known cardiac disease. Several etiological models have been proposed to explain the processes involved in the initiation and maintenance of NCCP, and the persisting functional impairment found in NCCP patients (3,30,31). These models suggest that individuals with NCCP misinterpret minor physical symptoms as signs of serious disease causing increased pain, anxiety, and disability, which maintain the problem in a vicious cycle (3). Psychological problems, particularly severe anxiety and panic attacks, are viewed as important precipitating factors for the development and maintenance of NCCP. Cognitive factors such as catastrophic thinking, negative appraisals, and selective attention play a central role in all of the etiological models. Cognitions are thought to affect patients' emotional and behavioral responses to physical symptoms leading to avoidance of activities, social withdrawal, disruptions in work, and physical and psychosocial disability (3,30,31). One important cognition to consider in this population is pain catastrophizing, which is the tendency to exaggerate the threat value of pain sensations, ruminate upon them, and feel helpless when experiencing pain (32). NCCP patients are more likely to report catastrophizing thoughts when faced with pain compared to other patients (33), and reducing catastrophic thoughts about the medical causes of chest pain has been associated with decreased chest pain in NCCP patients (34). It is assumed that pain, anxiety, and catastrophizing thoughts contribute to a vicious cycle that ultimately leads to disability in NCCP patients (3). While pain catastrophizing may be a common mechanism through which both pain and anxiety lead to disability, formal tests of these relationships have not been conducted in NCCP patients. Given the prominent role of anxiety in NCCP, it is unclear whether pain catastrophizing will demonstrate strong relationships with disability after accounting for the impact of anxiety. Further, it is not known if the effects of pain catastrophizing differ across domains of functioning (e.g., physical disability vs. psychosocial disability). Understanding pain catastrophizing's contribution to disability across different domains of functioning is important for developing and improving treatments for NCCP patients. For example, if pain catastrophizing is found to significantly contribute to psychosocial disability, we would expect that intervention strategies (e.g., cognitive restructuring) specifically designed to target catastrophic thoughts would be needed to yield benefits in psychosocial functioning. In this case, providing patients with medication alone or strategies that target other behavioral factors (e.g., avoidance of physical activity) may not result in improved psychosocial functioning. It is also possible that pain catastrophizing may no longer contribute to a particular domain of disability after accounting for anxiety. In this case, strategies to reduce anxiety would be needed to yield benefits. A better understanding of the relationships between pain catastrophizing and particular domains of functioning would help clinicians develop more targeted and efficient interventions (35). This study examined the contributions of chest pain, trait anxiety, and pain catastrophizing to disability in a sample of patients with NCCP. Linear path model analyses were conducted to examine these relationships across multiple domains of disability including physical disability, psychosocial disability, and disability in work, home, and recreational activities. We tested whether chest pain and trait anxiety were indirectly related to disability via pain catastrophizing. Because these data are correlational, the direction of the effects we tested was assumed. Separate path model analyses were conducted for each area of disability to examine whether pain catastrophizing played a more central role in some areas of disability than others. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|