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: 10710208
• 负责人: John W. Burns
• 金额: $ 77.02万
• 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/10710208
• 关键词: Address; Adult; Advisory Committees; Alexithymias; Awareness; Back; Behavioral; Belief; Brain; Characteristics; Chronic; Clinical; Cognitive Therapy; Compassion; Emotional; Event; Intervention; Mediating; Mediator; Meta-Analysis; Modeling; Neck; Outcome; Pain; Pain management; Pathway interactions; Patients; Persons; Predictive Factor; Process; Proliferating; Public Health; Randomized; Recommendation; Recording of previous events; Reporting; Research; Scientist; Spinal; Spine pain; Testing; Theoretical model; Therapeutic; Trauma; Treatment Efficacy; Vertebral column; Work; chronic musculoskeletal pain; chronic pain management; comparative; comparative trial; coping; improved; improved outcome; 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。许多社会心理治疗 近几十年来出现了，以帮助解决这个问题。这些干预措施已被证明是 与很大程度上惰性控制条件相比，有效；但是，最近的荟萃分析表明 这些治疗中的大多数的特征是对主要结果的适度影响。这是一个关键 这些原本承诺的方法的缺点。而不是尝试提高效率 制定新的和希望更强大的干预措施，我们也可以在已经经过证明的 治疗方法来增强治疗效果的幅度。一种策略是增加我们的 了解治疗介质。需要进行调解人的研究，直接比较不同的 彼此治疗以确定哪些介体特定于治疗方 治疗，这对临床结果贡献最大。可以使用此类研究的发现 告知对现有治疗的改编，以提高其利益。增加的第二个策略 现有治疗的有益作用是确定适度治疗的患者特征 回答。需要研究以理论模型为指导的研究，并测试主持人的多个 治疗。识别更有可能对一种或另一种治疗反应的患者的亚组可以进步 精确医学通过告知可以优化治疗效果的先验患者治疗匹配。我们将 比较认知行为疗法（CBT）的机制和主持人，接受和 承诺疗法（ACT）以及情感意识和表达疗法（EAET）。检查 这些治疗方法的介体和主持人具有推进治疗发展和 提高治疗效率。患有慢性脊柱（轴向）疼痛（n = 460）的成年人将随机分配给CBT， ACT，EAET和治疗与常规（TAU）。目标1是确定跨越特定和共享的调解人 治疗。目的2是识别跨治疗的主持人。这个项目可以增加我们的影响 通过识别最有力的治疗机制（特定）和 共享 - 并揭示了调解人结果途径很强。通过增加 了解调解人和主持人，可以开发出更有效的疼痛治疗方法， 测试并实施。