Behavior Analysis of Chronic Low Back Pain

慢性腰痛的行为分析

• 批准号: 7140521
• 负责人: LOUIS A GIORDANO
• 金额: $ 15.98万
• 依托单位: DUKE UNIVERSITY
• 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 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7140521
• 关键词: analgesics; backache; behavior test; behavioral /social science research tag; chronic pain; clinical research; coping; functional ability; human subject; interview; personal log /diary; psychological stressor; questionnaires; social support network; videotape /videodisc

DESCRIPTION (provided by applicant): A basic assumption of behavioral treatment for chronic pain is that a time-contingent pattern of coping improves functioning, whereas a pain-contingent pattern increases disability. However, despite the fact that many chronic pain treatment programs now address time- vs. pain-contingent patterns of coping behaviors, very few studies have directly tested the effects of these patterns of coping in patients with chronic pain. The primary aim of this study is to use electronic diaries to rigorously evaluate whether patients with chronic pain whose pain coping behaviors show more of a time-contingent pattern demonstrate better adjustment to pain and decreased delay discounting. A sample of 150 patients with chronic low back pain (CLBP: daily pain>6 months in duration) will participate. All subjects will participate in comprehensive evaluation sessions during which we will collect validated measures of psychological distress, physical disability, pain behavior, and delay discounting, before and after an intervening 30-day period. During the 30-day period, 100 randomly selected subjects will complete electronic diaries 3 times daily to measure levels of positive and negative affect, physical functioning, pain coping efficacy, and analgesic intake. Time-contingent coping efforts are those that occur on a regular basis, as measured by the coefficient of variation (variance/Mean) in coping and are not correlated with immediate pain intensity. Data analyses will determine if time-contingent coping relates to diary-based measures of adjustment in CLBP (positive and negative affect, physical functioning, pain coping efficacy, and analgesic intake) and well-validated cross-sectional measures of psychological distress, physical disability, pain behavior, and delay discounting. Lagged within-day assessments will allow us to calculate the extent that coping efforts follow increased pain at the previous occasion within the day. Analyses will assess subjects' general health, pain diagnosis, levels of pain, opioid use, quality of social support, small and major stressors to control for factors that may influence pain coping patterns. If the current study finds that diary-based measures of time-contingent and pain-contingent coping patterns are related to measures of adjustment to pain, then clinicians may wish to incorporate such diaries into their treatment protocols. If a time-contingent pattern of coping is related to delay discounting, then future studies might explore the effects of interventions designed to increase how patients value delayed outcomes. This study may lead to major advances in our understanding of CLBP, enlarge our clinical armaments for effectively treating CLBP, and may reduce the high societal costs associated with this painful disorder.

描述（由申请人提供）：慢性疼痛行为治疗的基本假设是，应对的时间持续模式可以改善功能，而疼痛的模式会增加残疾。然而，尽管许多慢性疼痛治疗计划现在解决了应对行为的时间与疼痛的模式，但很少有研究直接测试了这些应对模式对慢性疼痛患者的影响。这项研究的主要目的是使用电子日记来严格评估慢性疼痛的患者是否表现出更多的时间延长模式，这表明可以更好地适应疼痛和减少延迟折现。 150例慢性腰痛患者（CLBP：每天疼痛> 6个月）将参加。所有受试者都将参加全面的评估会议，在此期间，我们将在中间和之后收集经过验证的心理困扰，身体残疾，疼痛行为和延迟打折的措施。在30天期间，每天100个随机选择的受试者将完成3次电子日记，以测量正面和负面影响的水平，身体功能，疼痛应对功效和镇痛摄入量。按时应对工作是定期发生的，这是由应对中的变异系数（方差/平均值）衡量的，并且与直接疼痛强度无关。数据分析将确定时间持续的应对是否与基于日记的CLBP调节度量有关（正面和负面影响，身体功能，疼痛应对功效和镇痛摄入量）以及精心验证的心理困扰，身体残疾，疼痛行为，疼痛行为和延迟打折的横断面术。滞后于日期的评估将使我们能够计算应对努力遵循一天内疼痛增加的程度。分析将评估受试者的一般健康，疼痛诊断，疼痛程度，阿片类药物的使用水平，社会支持质量，小小的压力源，以控制可能影响疼痛应对模式的因素。如果当前的研究发现基于日记的时间持续和疼痛应对模式的度量与适应疼痛的措施有关，那么临床医生可能希望将这些日记纳入其治疗方案中。如果应对的时间控制模式与延迟折现有关，那么未来的研究可能会探讨旨在增加患者如何评价延迟结果的干预措施的影响。这项研究可能会导致我们对CLBP的理解，扩大我们的临床武器以有效治疗CLBP，并可以降低与这种疼痛疾病相关的高社会成本。