緊張型頭痛患者の痛みに対する破局的思考と痛みに対する恐怖が日常生活への支障度に及ぼす影響  [in Japanese] The Influence of Pain Catastrophizing and Fear of Pain on Daily Disability with Tension-type Headache Patients  [in Japanese]

本研究の目的は,腰背部痛などの慢性疼痛の先行研究で提唱されてきているモデルに基づき,緊張型頭痛における,痛みの維持・悪化のメカニズムの臨床的妥当性を検証することであった.成人の緊張型頭痛患者72名を対象に,共分散構造分析を用いてモデルを検討した結果,モデルの適合度はGFI=0.86,CFI=0.94,RMSEA=0.078であり,モデルの妥当性が確認された.この結果から,腰背部痛などの慢性疼痛を対象として提唱されている「痛みの維持・悪化モデル」が緊張型頭痛患者に適用され,緊張型頭痛の日常生活への支障度は,痛みに対する破局的思考と痛みに対する恐怖の行動的側面である逃避・回避行動の両方の変数の影響を受けていることが示された.

Objectives: It is likely that tension-type headache becomes chronic. However, the mechanism of maintenance and aggravation of pain is still unclear. Recentry, with regard to chronic pain such as low back pain, the model for explaining its mechanism has been propounded. In the model, both escape/avoidance, which is the behavioral aspect of fear of pain, and pain catastrophizing evolve to pain-related disability and cause persisting pain (Cook et al., 2006). Therefore, in our study, we investigated whether or not the mechanism of chronic pain which has verified mainly chronic pain like low back pain could be applied to tension-type headache. Methods: The participants of this study were 72 patients who met the International Headache Society Diagnostic Criteria for tension-type headache (27 males, 45 females; mean age 51.35, SD=15.30). They were required to complete a set of questionnaires. The set included (1) Headache Characteristics (including headache frequency, duration, and intension), (2) Hospital Anxiety and Depression Scale (HAD): depression, (3) Pain Catastrophizing Scale (PCS), (4) Pain Anxiety Symptoms Scale-20 (PASS-20): escape/avoidance, and (5) Headache Impact Test-6 (HIT-6). We confirmed the fit of the model by using structural equation modeling (SEM). Results: As a result, we found that the hypothetical model had a good fit in tention-type headache patients. It was revealed that pain catastrophizing directly influenced daily disability (0.36) and escape/avoidance (0.68). Moreover, escape/avoidance, strengthened by the pain catastrophizing, also influenced daily disability (0.34). Conclusion: We determined that pain catastrophizing and escape/avoidance were the important variables to address when considered pain chronicity for tention-type headache. Therefore, both pain catastrophizing and escape/avoidance can be assessed and dealt with in psychosomatic treatment for patients of tention-type headache. Further studies are needed to clarify the effect of intervention on patients targeted pain catastrophizing and escape/avoidance.