Pain is a complex construct contributing to significant impairment, particularly among physically injured patients seeking treatment in trauma and orthopedic surgery settings in which social workers are an integral component of care. The biopsychosocial theory, fear-avoidance, and cognitive mediation models of pain suggest that psychological factors (for example, depression) affect one’s ability to tolerate distress, leading to negative pain appraisals, such as catastrophizing. This study examined whether distress tolerance serves as a mechanism by which depression is associated with pain catastrophizing. We administered a health survey to outpatient trauma and orthopedic surgery clinic patients who were using opioid medications; 84 patients were included in the final analysis; 39.3 percent screened positive for depression. A multilevel mediation model using structural equation modeling revealed a significant direct effect from depression to pain catastrophizing (ß = .31, z = 3.96, p < .001) and a significant indirect effect by distress tolerance (Δß = .27, z = 3.84, p < .001). These results, which suggest that distress tolerance partially mediated the path from depression to pain catastrophizing, can inform social workers and other members of the multidisciplinary team about both the critical role of psychosocial factors after injury and interventions to improve postinjury recovery.

中文翻译：

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身体受伤患者的疼痛评估：评估应激耐受性在抑郁和疼痛灾难化之间的关系中的作用


疼痛是一种复杂的结构，会导致严重的损伤，特别是对于在创伤和骨科手术环境中寻求治疗的身体受伤患者来说，而社会工作者是护理中不可或缺的组成部分。生物心理社会理论、恐惧回避和疼痛的认知中介模型表明，心理因素（例如抑郁）会影响一个人忍受痛苦的能力，导致对疼痛的负面评价，例如灾难化。这项研究检验了痛苦耐受性是否是抑郁症与疼痛灾难化相关的一种机制。我们对门诊创伤和骨科手术诊所使用阿片类药物的患者进行了健康调查；最终纳入84例患者分析； 39.3% 的抑郁症筛查结果呈阳性。使用结构方程模型的多级中介模型揭示了抑郁对疼痛灾难化的显着直接影响 (ß = .31, z = 3.96, p < .001) 以及痛苦耐受力的显着间接影响 (Δß = .27, z = 3.84，p < .001)。这些结果表明，痛苦耐受力在一定程度上介导了从抑郁到疼痛灾难性的过程，可以让社会工作者和多学科团队的其他成员了解受伤后心理社会因素的关键作用以及改善受伤后恢复的干预措施。