Study On Global Pain Experience And Cognition-related Factors In Patients With Primary Gout

Objective The purpose of this study is to investigate the current status of global pain experience in patients with primary gout and to explore its influencing factors;to analyze the correlation between cognitive factors and global pain experience.Further more,the mechanism of cognition-related factors on the global pain experience is explored based on stress and coping theory,which can provide basis for formulating targeted pain management plan in primary gout patients.Methods Convenience sampling method was used to conduct a cross-sectional survey of400 patients with primary gout who visited Shandong Gout Clinical Medical Center from August 2020 to March 2021.We used a general information questionnaire,together with Global Pain Scale,Mishel Uncertainty in Illness Scale for Adult,Pain Self-Efficacy Questionnaire,Pain Appraisal Inventory-Short Form,and Coping Strategies Questionnaire-Revised.Paper questionnaires were applied in this survey.Statistical analysis of the data was performed using SPSS 25.1 software.Qualitative data were expressed as frequency and constituent ratio(%),while quantitative data were expressed as (?)±s or M(QL,QU).Independent sample t-test and one-way analysis of variance were carried out to explore the scores of the global pain experience with different characteristics.The correlation between each cognitive factor and global pain experience was analyzed by Pearson correlation or Spearman correlation.And the main influencing factors of global pain experience were examined by multiple linear regression.AMOS 26.0 software was used to construct the structural equation model.The structural equation model was constructed by AMOS 26.0 software and verified to clarify the mechanism of cognition-related factors on the global pain experience.Results1.The Global Pain Scale score of patients with primary gout was(36.14±18.13).The median of Mishel Uncertainty in Illness Scale for Adult score was 87.00,medium level was 85.15%.Pain Self-Efficacy Questionnaire score of patients with primary gout was(36.57±11.32),and the scoring rate was 60.95%.Pain Appraisal Inventory-Short Form score was(33.52±8.54),its dimensions scores of threat and challenge were(19.88±5.78)and(13.64±6.00).Coping Strategies Questionnaire-Revised score was(62.80±21.76),then active coping strategy and avoidant coping strategy were extracted by secondary factor analysis.2.Univariate analysis showed that different permanent residence,smoking,drinking,exercise,diagnosis and treatment,serum uric acid value,BMI,medication,pain location and flare frequency had significantly statistical effects in global pain experience among primary gout patients(P<0.05).Pearson correlation analysis exhibited that the total score of pain appraisal was positively correlated with the total score global pain experience(r=0.497,P<0.01),the total score of self-efficacy and coping strategies were negatively correlated with global pain scale(r=-0.483,P<0.01;r=-0.452,P<0.01).Spearman correlation analysis showed that illness uncertainty was positively related to global pain scale(rs=0.436,P<0.01).3.Further multiple linear regression analysis showed that the main factors affecting the global pain experience of patients with primary gout were pain location,serum uric acid value,smoking,drinking,exercise,illness uncertainty,self-efficacy,pain appraisal and coping strategies.The above nine variables explained 46.0% of the variance of global pain experience of patients with primary gout.4.Structural equation model showed that there were three paths of illness uncertainty to global pain experience: illness uncertainty to global pain experience;illness uncertainty to pain appraisal to active coping strategy to global pain experience.There was three paths of self-efficacy to global pain experience: self-efficacy to global pain experience;self-efficacy to active coping strategy to global pain experience;self-efficacy to pain appraisal to global pain experience.There was one path of pain appraisal to global pain experience: pain appraisal to global pain experience.There was one path of active coping strategy to global pain experience: active coping strategy to global pain experience.Illness uncertainty(β=0.268,P<0.001),self-efficacy(β=-0.308,P<0.001)and active coping strategy(β=-0.262,P<0.001)had a direct effect on global pain experience;pain appraisal(β=0.093,P<0.001)had an indirect effect on global pain experience.The mediating active coping strategy in self-efficacy to global pain experience path was0.101.The mediating active coping strategy in pain appraisal to global pain experience path was 0.093.The dual mediating active coping strategy and pain appraisal in illness uncertainty to global pain experience path was 0.052.The dual mediating active coping strategy and pain appraisal in self-efficacy to global pain experience path was 0.015.Conclusions1.The global pain experience of patients with primary gout is poor.Among primary gout patients,the illness uncertainty is at the medium level,the self-efficacy isn’t high,the tend of pain evaluation is threatening,and active coping strategy is more accepted.2.The global pain experience of patients with primary gout are affected by pain location,serum uric acid,smoking,drinking,exercise,illness uncertainty,self-efficacy,pain appraisal and coping strategies.3.The higher the score of illness uncertainty and threatening pain appraisal,the higher the score of global pain scale and the lower the global pain experience of in primary gout patients.The higher the score of self-efficacy and active coping strategy,the lower the score of global pain scale and the higher the global pain experience of in primary gout patients.4.Illness uncertainty can directly and positively affect global pain experience,while self-efficacy and active coping strategy can directly and negatively affect global pain experience of patients with gout.Pain appraisal cannot directly affect global pain experience,but can play an indirect effect by active coping strategy to affect global pain experience.Targeted interventions should pay attention to the illness uncertainty,enhance self-efficacy and guide to positively evaluate pain and actively cope pain to improve global pain experience in primary gout patients.