Comparison of CAM and Conventional Mind-Body Therapies for Chronic Back Pain

CAM 与传统身心疗法治疗慢性背痛的比较

• 批准号: 8528480
• 负责人: DANIEL C. CHERKIN
• 金额: $ 73.27万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8528480
• 关键词: Address; Adult; American; Anxiety; Awareness; Back; Back Pain; Behavioral; Belief; Breathing Exercises; Caring; Characteristics; Chronic; Chronic low back pain; Clinical; Cognition; Cognitive; Cognitive Therapy; Complementary and alternative medicine; Coping Behavior; Disabled Persons; Effectiveness; Expenditure; Feeling; Functional disorder; Guidelines; Health; Health Status; High Prevalence; Intervention; Knowledge; Life; Measures; Mediating; Mediator of activation protein; Medical; Medical Care Costs; Meditation; Mental Depression; Mind-Body Intervention; Outcome; Pain; Pain Research; Pain interference; Participant; Patients; Persons; Policies; Population; Public Health; Randomized; Recruitment Activity; Relaxation; Relaxation Therapy; Research; Rest; Safety; Self Efficacy; Signal Transduction; Sleep disturbances; Stress; Subgroup; Therapeutic; Thinking; Training; Treatment Cost; Yoga; aged; base; chronic back pain; comparative effectiveness; compare effectiveness; coping; cost; cost effective; cost effectiveness; effective therapy; experience; functional status; improved; mindfulness; mindfulness-based stress reduction; primary outcome; progressive relaxation therapy; psychologic; randomized trial; response; secondary outcome; systematic review; treatment as usual; treatment effect

DESCRIPTION (provided by applicant): Chronic back pain remains one of the most common and challenging public health problems in the U.S. Although the amount of money spent on back pain treatments has increased substantially over the past decade in the U.S., the health and functional status of persons suffering from back pain has deteriorated. There is a clear need to identify safe, effective, and cost-effective treatment options for this often debilitating and expensive problem. Some of the more promising treatments for chronic back pain include "mind-body" therapies that address both psychological and somatic aspects of the pain experience. This randomized trial will compare the effectiveness and cost-effectiveness of Mindfulness-Based Stress Reduction (MBSR), a well- established but inadequately-studied CAM mind-body therapy, with usual care for persons with chronic low back pain and dysfunction. This trial will also compare MBSR with a conventional mind-body therapy, Cognitive-Behavioral Therapy (CBT), which has been found to be a modestly to moderately effective treatment for chronic back pain. Should MBSR and/or CBT prove effective in this trial, the mechanisms (mediators) of the effects of these two different mind-body therapies on pain and dysfunction will be explored. Because CBT aims to alter patients' cognitive and behavioral responses to pain, whereas MBSR focuses on direct present moment experience and not on changing the thoughts or feelings about such experience, these two therapies are hypothesized to operate by different mechanisms. A total of 297 adults aged 20 through 64 years who have moderately to severely disabling chronic back pain will be recruited and randomized in equal proportions to MBSR, CBT, and treatment as usual (usual care). Both the MBSR and CBT interventions will be provided to groups of 11 participants once a week for 8 weeks. The primary outcomes will be back pain-related functional limitations (Roland scale) and pain bothersomeness (rated on a 0-10 scale). Secondary outcomes include depression, anxiety, perceived stress, pain interference with activities, and sleep disturbance. Outcomes will be measured 5, 10, 26, and 52 weeks after randomization. If MBSR is at least moderately more effective than usual care, this safe and relatively inexpensive therapy would provide an appealing treatment option for chronic back pain that could be made more widely available. Because of the high prevalence and costs of chronic back pain, treatments with even modest impact on pain and function could produce a large benefit on a population level.

描述（由申请人提供）：慢性背痛仍然是美国最常见，最具挑战性的公共卫生问题之一，尽管在过去十年中，用于背痛治疗上的金额已大大增加，但患有背部疼痛的人的健康和功能状况已经恶化。显然需要确定这种经常使人衰弱且昂贵的问题的安全，有效且具有成本效益的治疗选择。慢性背痛的一些更有前途的治疗方法包括“心身”疗法，这些疗法既解决疼痛经历的心理和躯体方面。这项随机试验将比较基于正念的压力减轻（MBSR）的有效性和成本效益（MBSR），这是一种良好但不充分的CAM思维疗法，与慢性下背部疼痛和功能障碍患者的通常护理。该试验还将将MBSR与常规的思维疗法，认知疗法（CBT）进行比较，该疗法已被发现是适度的适度有效治疗的慢性背痛。如果MBSR和/或CBT在此试验中有效，则将探索这两种不同的思维疗法对疼痛和功能障碍的作用的机制（介体）。由于CBT的目的是改变患者对疼痛的认知和行为反应，而MBSR专注于直接的当前时刻经验，而不是改变对这种经历的思想或感觉，因此这两种疗法被假设以不同的机制运作。总共有297名20至64岁的成年人中度至严重致残的慢性背痛，将与MBSR，CBT和治疗相同的比例随机招募和随机分配（通常（通常的护理））。 MBSR和CBT干预措施都将每周向11名参与者组成的组提供8周。主要结果将是与背部疼痛相关的功能局限性（Roland量表）和疼痛麻烦（以0-10级评分）。次要结果包括抑郁，焦虑，感知压力，对活动的疼痛干扰和睡眠障碍。随机分组后的5、10、26和52周的结果将测量。如果MBSR至少比通常的护理更有效，那么这种安全且相对廉价的疗法将为慢性背痛提供一种吸引人的治疗选择，可以使可以更广泛地使用。由于慢性背痛的高患病率和成本高，对疼痛和功能的影响甚至适度的治疗可能会在人群水平上产生很大的好处。