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，随时间变化的应对模式可以改善功能，而随时间变化的应对模式会增加残疾。然而，尽管事实上许多慢性疼痛治疗方案现在都针对时间与疼痛相关的应对行为模式，但很少有研究直接测试这些应对模式对慢性疼痛患者的影响。本研究的主要目的是使用电子日记来严格评估其疼痛应对行为更多地表现出时间相关模式的慢性疼痛患者是否表现出更好的疼痛调整能力和减少的延迟贴现。 150 名慢性腰痛（CLBP：每日疼痛持续时间>6 个月）患者样本将参与其中。所有受试者都将参加综合评估会议，在此期间，我们将在 30 天的干预期之前和之后收集经验证的心理困扰、身体残疾、疼痛行为和延迟折扣测量指标。在 30 天期间，100 名随机选择的受试者将每天完成 3 次电子日记，以测量积极和消极情绪、身体机能、疼痛应对功效和镇痛摄入量的水平。随时间变化的应对努力是那些定期发生的应对努力，通过应对的变异系数（方差/平均值）来衡量，并且与即时疼痛强度无关。数据分析将确定时间相关的应对是否与基于日记的 CLBP 调整措施（积极和消极情绪、身体机能、疼痛应对功效和镇痛剂摄入量）以及经过充分验证的心理困扰、身体残疾的横断面测量措施相关、痛苦行为和延迟折扣。滞后的日内评估将使我们能够计算出当天内前一次疼痛加剧后的应对努力程度。分析将评估受试者的总体健康状况、疼痛诊断、疼痛程度、阿片类药物的使用、社会支持的质量、小压力和大压力，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相关和疼痛相关的应对模式测量与疼痛调整测量相关，那么临床医生可能希望将此类日记纳入他们的治疗方案中。如果随时间变化的应对模式与延迟贴现有关，那么未来的研究可能会探讨旨在提高患者对延迟结果的重视程度的干预措施的效果。这项研究可能会导致我们对 CLBP 的理解取得重大进展，扩大我们有效治疗 CLBP 的临床武器，并可能降低与这种痛苦的疾病相关的高昂社会成本。