복합부위통증증후군 환자들의 MMPI 프로파일 및 심리적 특성
MMPI Profiles and the Other Psychometric Characteristics of Patients with Complex Regional Pain Syndrome
조선미 (아주대학교)
임기영 (아주대학교)
김찬 (아주대학교)
한경림 (아주대학교)
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초록
본 연구는 복합부위통증증후군 환자들의 심리적 특성을 살펴보고자 하였다. 복합부위통증증후군(Complex Regional Pain Syndrome: CRPS)은 사지의 외상이나 신경손상, 골절, 뇌졸중, 척수손상, 심근경색 등 다양한 인자에 의해 발생하는 신경병증성 통증이다. 복합부위통증증후군의 발병 기전에 대해서는 아직까지 논란이 있으나, 발병 및 경과에 있어 심리적인 요인이 많이 관여되어 있는 것으로 알려져 있다. 참여자는 102명의 복합부위통증증후군 환자들이었고, 이들의 인구통계학적 자료들, 질병행동질문지, 다차원 건강 통제척도, 통증대처전략질문지, MMPI T 점수결과가 분석되었다. 그 결과, 복합부위통증증후군 환자들의 MMPI 프로파일은 세 개의 하위 군집으로 구분되었다. 즉 군집 Ⅰ은 Hs와 Hy가 상승된 전환 V형태를 보였으며, 군집 Ⅱ는 비교적 정상프로파일을 보이는 집단으로 군집 Ⅲ에 비해 내적통제를 더 많이 나타냈다. 군집 Ⅲ은 신경증 세 척도(Hs, D, Hy)와 함께 정신증 세 척도(Pa, Pt, Sc)가 동시에 상승되어 있는 것으로 나타났다. 또한 질병행동 특성에 있어서 건강염려, 질병확신, 감정억제, 정서적 혼란감 척도에서 다른 하위집단에 비해 높은 점수를 보였으며, 대처방식에 있어서는 군집 Ⅱ에 비해 재앙적 사고가 높게 나타났다. 이러한 결과로 볼 때, 복합부위통증증후군 환자의 심리치료에 있어서 이들 하위유형군 간의 적절한 치료적 접근이 고려되어야 할 것으로 보이며, 일부 환자의 경우는 정신과적인 치료적 개입과 함께 통증대처전략을 수정시키는 훈련 프로그램이 치료에 큰 도움을 줄 수 있을 것으로 기대된다.
- keywords
- complex regional pain syndrome, MMPI, illness behavior, health locus of control, pain-coping, complex regional pain syndrome, MMPI, illness behavior, health locus of control, pain-coping, 복합부위통증증후군, MMPI, 질병행동, 건강통제소재, 통증대처
Abstract
This study aimed at identifying the psychometric characteristics of patients with complex regional pain syndrome (CRPS). CRPS refers to neuropathic pain disorders developing as a disproportionate consequence of painful trauma or a nerve lesion affecting the limbs or a bone fracture, or as a consequence of a remote process like stroke, spinal cord injury or myocardial infarction. Although CRPS mechanism for the disease is still controversial, its onset and progress are widely known to be related to psychological factors. The subjects of this study included 102 patients suffering from CRPS. Their demographic data, responses to the illness behavior questionnaire (IBQ), multidimensional health locus of control scale (MHLC) and coping strategies questionnaire (CSQ), and their MMPI T scores were analyzed. Multivariate clustering analysis divided the patients' MMPI profiles into three homogeneous subgroups. Group I was characterized by 'conversion V' pattern with elevated Hs and Hy scores. Group II showed relatively normal profiles, but had more internal control than group III. Group III showed simultaneous increases in Hs-D-Hy scores and Pa-Pt-Sc scores. It also acquired higher scores than the other two subgroups in illness behavior characteristics, such as the hypochondriasis, disease conviction, affective inhibition and affective disturbance. Besides, with respect to a way to handle the pain, group III displayed more disastrous thinking than group II. In conclusion, an appropriate therapeutic approach that takes into account the characteristics of each sub group should be considered in the psychological treatment of patients suffering from CRPS.
- keywords
- complex regional pain syndrome, MMPI, illness behavior, health locus of control, pain-coping, complex regional pain syndrome, MMPI, illness behavior, health locus of control, pain-coping, 복합부위통증증후군, MMPI, 질병행동, 건강통제소재, 통증대처
참고문헌
김영환, 김재환, 김중술, 노명래, 신동균, 염태호, 오상우 (1989). 다면적 인성검사. 서울: 한국가이던스.
김중술 (1988). 다면적 인성검사. 서울: 서울대학교 출판부.
김청송 (1999). 불안민감성이 동통반응에 미치는 영향. 중앙대학교대학원 박사학위 청구논문.
박상현, 이평복, 임윤희, 이승윤, 최인용, 이상진, 오용석 (2006). 제 1형 복합부위 통증증후군의 진단에서 적외선 체열측정과 3상 골스캔의 유용성. 대한통증학회지, 19(1), 81-86.
심영숙, 이영호 (1990). 두통 환자들의 MMPI 특성. 한국심리학회지: 임상, 9(1), 155-168.
이기련, 이영호 (2003). 신체형장애 환자들의 질병행동 특성. 한국심리학회지: 임상, 22(1), 57-70.
이종문, 장상현, 유성옥, 최윤경, 고성범, 박민규, 박건우, 이대희 (2003). 긴장형두통 환자의 심리적 특성: MMPI를 중심으로. 대한신경과학회지, 21 (6), 600-605.
지영숙 (1987). 입원환자의 스트레스와 스트레스 대처방법 및 통제위 성격과의 관계연구. 연세대학교 교육대학원 석사학위 청구논문.
Bonica, I. J., Loster, I. D., Butler, S. H., Chapman, C. R., & Turk, D. C. (2001). The management of pain, 3rd ed. Philadelphia: Lippincott Williams & Wilkins.
Breuhl, S. (2001). Do psychological factors play a role in the onset and maintenance of CRPS-Ⅰ? In R. N. Harden, R. Baron, & W. Janig(Eds.), Complex Regional Pain Syndrome, Progress in Pain Research and Management, 22. Seattle, WA: International Association for the Study of Pain Press.
Bruehl, S., & Carlson, C. R. (1992). Predisposing psychological factors in the development of reflex sympathetic dystrophy: A review of the empirical evidence. Clinical Journal of Pain, 8(4), 287-299.
Bruehl, S., & Chung, O. Y. (2006). Psychological and behavioral aspect of complex regional pain syndrome management. Clinical Journal of Pain, 22(5), 430-437.
Chaves, J. F., & Brown, J. M. (1987). Spontaneous cognitive strategies for the control of clinical pain and stress. Journal of Behavioral Medicine, 10(3), 263-276.
Drossman, D. A., Leserman, J., Li, Z., Keefe, F., Hu, Y. J., & Toomey, T. C. (2000). Effects of coping on health outcome among women with gastrointestinal disorders. Psychosomatic Medicine, 62(3), 309-317.
Frank, R. G., & Elliott, T. R. (1989). Spinal cord injury and health locus of control beliefs. Paraplegia, 27(4), 250-256.
Franz, C., Paul, R., Bautz, M., Choroba, B., & Hildebrandt, J. (1986). Psychosomatic aspects of chronic pain: a new way of description based on MMPI item analysis. Pain, 26(1), 33-43.
Geertzen, J. H., de Bruijn-Kofman, A. T., de Bruijn, H. P., van de Wiel, H. B., & Dijkstra, P. U. (1998). Stressful life events and psychological dysfunction in complex regional pain syndrome typeⅠ. Clinical Journal of Pain, 14(2), 143-147.
Harden, R. N., Bruehl, S., Stanton-Hicks, M., & Wilson, P. R. (2007). Proposed new diagnostic criteria for complex regional pain syndrome. Pain Medicine, 8(4), 326-331.
Hart, R. R. (1984). Chronic pain: replicated multivariate of clustering of personality profiles. Journal of Clinical Psychology, 40(1), 129-133.
Lawson, K., Reesor, K. A., Keefe, F. J., & Turner, J. A. (1990). Dimensions of pain-related cognitive coping: cross-validation of the factor structure of the coping strategy questionnaire. Pain, 43(2), 195-204.
Levenson, J. L. (2005). The American psychiatric publishing textbook of psychosomatic medicine. Washington, DC: American Psychiatric Publishing, Inc.
Maihöfner, C., Handwerker, H. O., Neundörfer, B., & Birklein, F. (2004). Cortical reorganization during recovery from complex regional pain syndrome. Neurology, 63(4), 693-701.
McCreary, C., Naliboff, B., & Cohen, M. (1989). A comparison of clinically and empirically derived MMPI groupings in low back pain patients. Journal of Clinical Psychology, 45(4), 560-570.
Monti, D. A., Herring, C. L., Schwartzman, R. J., & Marchese, M. (1998). Personality assessment of patients with complex regional pain syndrome typeⅠ. Clinical Journal of Pain, 14(4), 295-302.
Payne, B., & Norfieet, M. A. (1986). Chronic pain and the family. Pain, 26(1), 1-12.
Pilowsky, I., & Spence, N. D. (1983). Manual for the Illness Behavior Questionnaire(IBQ). Adelaide: University of Adelaide.
Reedijk, W. B., van Rijn, M. A., Roelofs, K., Tuijl, J. P., Marinus, J., & van Hilten, J. J. (2008). Psychological features of patients with complex regional pain syndrome typeⅠ related dystonia. Movement Disorders, 23(11), 1551-1559.
Robinson, M. E., Riley, J. L. 3rd, Myers, C. D., Sadler, I. J., Kvaal, S. A., Geisser, M. E., & Keefe, F. J. (1997). The Coping Strategies Questionnaire: A large sample item level factor analysis. Clinical Journal of Pain, 13(1), 43-49.
Rommel, O., Malin, J. P., Zenz, M, & Jänig W. (2001). Quantitative sensory testing, neurophysiological and psychological examination in patients with complex regional pain syndrome and hemisensory deficits. Pain, 93(3), 279-293.
Rommel, O., Willweber-Strumpf, A., Wagner, P., Surall, D., Malin, J. P., & Zenz, M. (2005). Psychological abnormalities in patients with complex regional pain syndrome. Schmerz, 19(4), 272-284.
Rosenstiel, A. K., & Keefe, F. J. (1983). The use of coping strategies in chronic pain patients: Relationship to patient characteristics and current adjustment. Pain, 17(1), 33-44.
Stanton-Hicks, M., Baron, R., Boas, R., Gordh, T., Harden, N., Hendler, N., Koltzenburg, M., Raj, P., & Wilder, R. (1998). Complex regional pain syndromes: guidelines for therapy. Clinical Journal of Pain, 14(2), 155-166.
Strassberg, D. S., Reimherr, F., Ward, M., Russell, S., & Cole, A. (1981). The MMPI and chronic pain. Journal of Consulting and Clinical Psychology, 49(2), 220-226.
Strickland, B. R. (1978). Internal-external expectancies and health-related behaviors. Journal of Consulting and Clinical Psychology, 46(6), 1192-1211.
Turner, J. A., & Clancy, S. (1986). Strategies for coping with chronic low back pain: Relationship to pain and disability. Pain, 24(3), 355-364.
Wallston, K. A., Wallston, B. S., & Devellis, R. (1978). Developmental of the multidemensional health locus of control scales. Health Education Monographs, 6(1), 161-170.
Wasner, G., Schattschneider, J., Binder, A., & Baron, R. (2003). Complex regional pain syndrome- diagnostic, mechanisms, CNS involvement and therapy. Spinal Cord, 41(2), 61-75.
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