Comparative Mechanisms (Mediators, Moderators) of Psychosocial Chronic Pain Treatments

社会心理慢性疼痛治疗的比较机制（中介、调节因素）

• 批准号: 10564263
• 负责人: John W. Burns
• 金额: $ 54.57万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10564263
• 关键词: Address; Adult; Advisory Committees; Alexithymias; Awareness; Back; Behavior Therapy; Behavioral; Belief; Brain; Characteristics; Chronic; Clinical; Cognitive Therapy; Compassion; Emotional; Event; Gold; Intervention; Mediating; Mediator of activation protein; Meta-Analysis; Modeling; Neck Pain; Outcome; Pain; Pain management; Pathway interactions; Patients; Persons; Predictive Factor; Process; Proliferating; Public Health; Randomized; Recording of previous events; Reporting; Research; Scientist; Spinal; Spine pain; Testing; Theoretical model; Therapeutic; Trauma; Treatment Efficacy; Work; base; chronic musculoskeletal pain; chronic pain management; comparative; comparative trial; coping; innovation; novel strategies; pain catastrophizing; patient subsets; precision medicine; primary outcome; psychosocial; theories; therapy development; treatment as usual; treatment effect; treatment optimization; treatment response; virtual

Chronic musculoskeletal pain (CP) is a major public health concern. A number of psychosocial treatments have emerged in recent decades to help address this problem. These interventions have been shown to be efficacious when compared to largely inert control conditions; however, recent meta-analyses indicate that most of these treatments are characterized by modest effects on primary outcomes. This is a critical shortcoming of these otherwise promising approaches. Rather than attempting to boost efficacy only by developing new and hopefully more powerful interventions, we can also look within our already proven treatments for ways to enhance the magnitude of treatment effects. One strategy is to increase our understanding of treatment mediators. Studies of mediators are needed that directly compare different treatments with each other to determine which mediators are treatment-specific, which are shared across treatments, and which contribute the most to clinical outcomes. The findings from such research could be used to inform adaptations to existing treatment that enhance their benefits. A second strategy for increasing the beneficial effects of existing treatments is to identify the patient characteristics that moderate treatment responses. Research is needed that is guided by theoretical models and that tests moderators across multiple treatments. Identifying subgroups of patients more likely to respond to one or another treatment can advance precision medicine by informing a priori patient-treatment matches that can optimize treatment effects. We will compare the mechanisms and moderators of Cognitive-Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Emotional Awareness and Expression Therapy (EAET). Examining the mediators and moderators of these treatments holds great potential for advancing treatment development and enhancing treatment efficacy. Adults with chronic spinal (axial) pain (N=460) will be randomly assigned to CBT, ACT, EAET and to treatment-as-usual (TAU). Aim 1 is to identify specific and shared mediators across treatments. Aim 2 is to identify moderators across treatments. This project can increase the effects of our psychosocial chronic pain treatments by identifying the most powerful treatment mechanisms – specific and shared -- and revealing for whom the mediator  outcome pathways are strongest. Via increased understanding of mediator and moderators, more effective pain treatment approaches can be developed, tested, and implemented.

慢性肌肉骨骼疼痛（CP）是一个主要的公共卫生问题，有多种心理社会治疗方法。 近几十年来，这些干预措施已被证明可以帮助解决这一问题。 与大部分惰性控制条件相比是有效的；然而，最近的荟萃分析表明 大多数治疗的特点是对主要结果影响不大，这是一个关键。 这些原本有希望的方法的缺点，而不是仅仅试图通过提高功效。 开发新的、希望更强大的干预措施，我们也可以审视我们已经证实的 治疗方法之一是提高治疗效果。 需要对治疗中介因素进行直接比较的研究。 相互进行治疗以确定哪些调节剂是治疗特异性的，哪些是跨组共享的 治疗方法，以及对临床结果贡献最大的方法可以使用此类研究的结果。 为现有治疗方法的调整提供信息，以增强其益处。 现有治疗的有益效果是确定调节治疗的患者特征 需要以理论模型为指导并测试多个主持人的研究。 确定更有可能对一种或另一种治疗产生反应的患者亚组可以推进治疗。 我们将通过告知先验的患者治疗匹配来进行精准医学，从而优化治疗效果。 比较认知行为疗法 (CBT)、接受和治疗的机制和调节因素 承诺疗法（ACT）和情绪意识和表达疗法（EAET）。 这些治疗的中介者和调节者在推进治疗开发和 提高治疗效果的慢性脊柱（轴）疼痛（N = 460）的成人将被随机分配到CBT， ACT、EAET 和照常治疗 (TAU) 的目标 1 是确定跨区域的特定且共有的调节因子。 目标 2 是确定不同治疗方法的调节因素，以提高我们的治疗效果。 通过确定最有效的治疗机制（具体和有效）来治疗心理社会慢性疼痛 共享——并揭示对于谁来说，中介结果途径是最强的。 了解中介者和调节者，可以开发更有效的疼痛治疗方法， 测试并实施。