Mechanisms of Psychosocial Chronic Pain Treatments

社会心理慢性疼痛治疗机制

• 批准号: 9130041
• 负责人: John W. Burns
• 金额: $ 64.31万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-25 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9130041
• 关键词: Address; Attention; Behavior Therapy; Behavioral; Chronic low back pain; Cognition; Cognitive; Cognitive Therapy; Data; Education; Event; Future; Intervention; Knowledge; Light; Link; Maintenance; Modeling; Outcome; Outcome Measure; Pain; Pain Research; Pain management; Pathway interactions; Patients; Persons; Procedures; Proliferating; Public Health; Randomized; Research; Resources; Science; Specific qualifier value; Techniques; Testing; Theoretical model; Therapeutic; Thinking; Treatment Efficacy; Work; active method; base; chronic pain; cognitive process; coping; design; effective intervention; follow-up; mindfulness; mindfulness-based stress reduction; neglect; programs; psychosocial; public health relevance; theories; treatment effect

DESCRIPTION (provided by applicant): Chronic low back pain is a major public health concern. Psychosocial pain interventions have proliferated, and some approaches have strong support for efficacy. Most research has been focused on questions regarding the overall efficacy of these treatments. However, important questions regarding the mechanisms by which these psychosocial pain treatments produce benefits have been neglected. We have not yet empirically determined how psychosocial pain treatments work. Addressing this knowledge gap requires that we shift attention in psychosocial pain research away from evaluating only treatment efficacy and toward research that uncovers effective core treatment mechanisms. We advance and propose to test 2 conceptual models of treatment mechanisms. First, the Specific Mechanisms Model holds that different treatments work primarily via mechanisms specific to the treatment. Thus, Behavioral Treatment (BT) theoretically works in persons with pain via changes in behavioral coping, Cognitive Therapy (CT) works via changes in cognitive content, and MBSR works via changes in cognitive process. In contrast, a second approach holds that psychosocial pain interventions are effective because they all operate via 1 or more shared mechanisms, and can be termed the Shared Mechanisms Model. This would include mechanisms heralded by 1 or more of the specific theories and general mechanisms that are reputed to be factors held in common by all viable psychosocial interventions (e.g., therapeutic relationship). To test the validity of the 2 models and identify the mechanisms critical for the efficacy of psychosocial pain treatments, 400 people with chronic low back pain will be randomly assigned to 1 of 4 treatments: BT, CT, MBSR, or a Pain Education control condition. Eight sessions of 1.5 hrs duration will be delivered. Mechanism and outcome measures will be assessed weekly. We will first determine which model - specific vs. shared - best explains the data. In the event that the Shared Mechanism Model is supported, further analyses will determine which mechanism(s) is (are) critical across the treatments. Next, we will evaluate effects of mechanisms beyond pre-post changes and focus on 6-12 mos follow-up. It may be that the mechanisms showing effects on salutary pre-post outcomes will be the same mechanisms exerting effects on 6-12 mos maintenance and/or enhanced outcomes. It may also be that mechanisms not showing strong associations with pre-post outcome changes may emerge as important predictors of 6-12 mos outcomes. Results will shed important new light on what makes psychosocial pain treatments work. ous project or program of research has to date. Such findings will increase understanding of the causal impacts of each of the hypothesized mechanisms on outcomes, and so reveal which one or more mechanisms should be the primary target(s) of treatment procedures and techniques. This will allow us to determine whether in further interventions we should focus all or most of our efforts on changing what people with chronic pain do, the content of their thoughts, how they respond to their thoughts, just two of these, or all three.

描述（由申请人提供）：慢性腰痛是一个主要的公共卫生问题。社会心理疼痛干预措施已经激增，并且一些方法的疗效得到了强有力的支持。大多数研究都集中在有关这些治疗的总体疗效的问题上。然而，有关这些社会心理疼痛治疗产生益处的机制的重要问题却被忽视了。我们尚未凭经验确定社会心理疼痛治疗的效果。解决这一知识差距需要我们将社会心理疼痛研究的注意力从仅评估治疗效果转向揭示有效核心治疗机制的研究。我们提出并建议测试两种治疗机制的概念模型。首先，特定机制模型认为不同的治疗主要通过特定于治疗的机制起作用。因此，理论上，行为治疗（BT）通过改变行为应对方式对疼痛患者起作用，认知疗法（CT）通过改变认知内容起作用，而MBSR则通过改变认知过程起作用。相比之下，第二种方法认为社会心理疼痛干预措施是有效的，因为它们都通过一个或多个共享机制起作用，并且可以称为共享机制模型。这将包括一种或多种特定理论和一般机制所预示的机制，这些理论和一般机制被认为是所有可行的心理社会干预措施（例如治疗关系）所共有的因素。为了测试这 2 个模型的有效性并确定对社会心理疼痛治疗效果至关重要的机制，400 名慢性腰痛患者将被随机分配接受 4 种治疗中的一种：BT、CT、MBSR 或疼痛教育控制条件。将举行八场会议，每次 1.5 小时。将每周评估机制和结果措施。我们将首先确定哪种模型（特定模型与共享模型）最能解释数据。如果支持共享机制模型，进一步的分析将确定哪些机制在治疗中至关重要。接下来，我们将评估除前后变化之外的机制的影响，并重点关注 6-12 个月的后续行动。对有益的术后结果产生影响的机制可能与对 6-12 个月维持和/或增强结果产生影响的机制相同。也有可能与前后结果变化没有表现出强烈关联的机制可能成为 6-12 个月结果的重要预测因子。研究结果将为社会心理疼痛治疗的有效原理提供重要的新线索。我们的项目或研究计划已经过时。这些发现将增进对每种假设机制对结果的因果影响的理解，从而揭示哪一种或多种机制应该是治疗程序和技术的主要目标。这将使我们能够确定，在进一步的干预中，我们是否应该将全部或大部分努力集中在改变慢性疼痛患者的行为、他们的想法内容、他们对想法的反应上，仅其中两个，还是全部三个。