Behavioral Interventions for Low Back Pain

腰痛的行为干预

• 批准号: 6964777
• 负责人: STEVEN Z GEORGE
• 金额: $ 7.28万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6964777
• 关键词: avoidance behavior; backache; behavior modification; behavior therapy; behavioral /social science research tag; behavioral medicine; belief; clinical research; clinical trials; data collection methodology /evaluation; exercise; fear; human subject; human therapy evaluation; longitudinal human study; outcomes research; questionnaires; rehabilitation; social psychology

DESCRIPTION (provided by applicant). The dominant role that psychosocial factors play in the development of chronic disability from low back pain has been well established in the literature. As a result, the investigation of biopsychosocial models for treatment of low back pain has been advocated by researchers. The Fear-Avoidance Model of Exaggerated Pain Perception (FAMEPP) is a biopsychosocial model that proposes an individual's pain related fear and avoidance is the most important factor in determining whether chronic disability results from an episode of low back pain. In the FAMEPP, individuals with high pain related fear and avoidance are hypothesized to use an avoidance response to low back pain and have deleterious physical and psychological consequences. Individuals with low pain related fear and avoidance are hypothesized to use a confrontation response to low back pain and gradually return to their normal social and physical functioning. Support for the validity of the FAMEPP is found in longitudinal studies that have demonstrated that pain related fear and avoidance significantly predicts future disability after a low back injury. Treatment based on the FAMEPP involves facilitating confrontation in individuals that normally would not use a confrontation response (i.e. those with high pain related fear and avoidance). Two specific behavioral interventions have been used to facilitate confrontation for patients with low back pain. Graded exposure facilitates confrontation by systematically exposing the individual to situations that they are fearful of and gradually increasing their exposure to such situations. Graded exercise facilitates confrontation by systematically increasing the patients' tolerance to activity (graded exercise). Investigations in the literature support the use of these behavioral interventions, but their effectiveness has not been investigated in patients before they have chronic low back pain. Behavioral interventions that effectively reduce future disability before the onset of chronic symptoms could potentially reduce societal and economic costs associated with low back pain. The purpose of this small grant (RO3) research proposal is to determine the efficacy of a graded exposure rehabilitation intervention for reducing future disability from sub-acute low back pain for patients with elevated fear-avoidance beliefs.

描述（由申请人提供）。 文献中已经明确，心理社会因素在腰痛导致的慢性残疾的发展中起主导作用。因此，研究人员提倡研究治疗腰痛的生物心理社会模型。夸大疼痛感知的恐惧回避模型（FAMEPP）是一种生物心理社会模型，提出个体与疼痛相关的恐惧和回避是确定慢性残疾是否由腰痛发作引起的最重要因素。在 FAMEPP 中，假设具有高度疼痛相关恐惧和回避的个体会对腰痛采取回避反应，并产生有害的身体和心理后果。据推测，患有与低疼痛相关的恐惧和回避的个体会对腰痛采取对抗反应，并逐渐恢复正常的社交和身体功能。纵向研究支持 FAMEPP 的有效性，这些研究表明，与疼痛相关的恐惧和回避可以显着预测腰部受伤后未来的残疾。基于 FAMEPP 的治疗涉及促进通常不会使用对抗反应的个体（即具有高度疼痛相关恐惧和回避的个体）的对抗。两种特定的行为干预措施已被用于促进腰痛患者的对抗。分级暴露通过系统地将个人暴露于他们害怕的情况并逐渐增加他们对这种情况的暴露来促进对抗。分级运动通过系统地提高患者对活动的耐受性（分级运动）来促进对抗。文献中的调查支持使用这些行为干预措施，但尚未在患有慢性腰痛的患者中研究其有效性。在慢性症状出现之前有效减少未来残疾的行为干预措施可能会降低与腰痛相关的社会和经济成本。这项小额赠款 (RO3) 研究计划的目的是确定分级暴露康复干预的有效性，以减少恐惧回避信念较高的患者因亚急性腰痛而导致的未来残疾。