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）：慢性下背痛是一个主要的公共健康问题。心理疼痛干预措施已经增殖，有些方法对功效有很大的支持。大多数研究都集中在有关这些治疗总体疗效的问题上。但是，有关这些社会心痛治疗产生益处的机制的重要问题已被忽略。我们尚未从经验上确定社会心理疼痛治疗的工作方式。解决这一知识差距需要我们将心理疼痛研究中的注意力转移到仅评估治疗效果而转向发现有效核心治疗机制的研究。我们进步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，不同的治疗方法主要通过特定的治疗机制起作用。因此，理论上的行为治疗（BT）通过行为应对，认知疗法（CT）通过认知含量的变化而在疼痛中起作用，而MBSR通过认知过程的变化来起作用。相比之下，第二种方法认为，社会心理疼痛干预是有效的，因为它们都通过1个或更多的共享机制运行，并且可以称为共享机制模型。这将包括由1个或更多特定理论和一般机制预示的机制，这些机制被认为是所有可行的社会心理干预措施（例如治疗关系）所持有的因素。为了测试这两种模型的有效性，并确定对社会心脏疼痛治疗功效至关重要的机制，将有400人随机分配给4种治疗方法中的1种：BT，CT，MBSR或疼痛教育控制条件。将交付八次1.5小时的会议。机制和结果指标将每周评估。我们将首先确定哪种模型 - 特定与共享 - 最能解释数据。如果支持共享机制模型，则进一步的分析将确定哪些机制在整个处理中至关重要。接下来，我们将评估超出验证前变化的机制的影响，并关注6-12 MOS随访。表现出对有益的前结果影响的机制可能是对6-12 MOS维护和/或增强结果的相同机制。也可能是，未显示与验证前结果变化有密切关联的机制可能是6-12 MOS结果的重要预测指标。结果将为什么使社会心脏疼痛治疗起作用。 OUS项目或研究计划已迄今为止。这样的发现将增加对每种假设机制对结果的因果影响的理解，因此揭示哪种机制应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措施中，我们是否应该将所有或大部分的努力集中在改变慢性痛苦的人所做的事情，他们的思想内容，他们如何应对自己的思想，仅两个或三个。