Mediators and moderators of chronic pain outcomes in an online self-management program.
Mediators and moderators of chronic pain outcomes in an online self-management program.
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在线自我管理计划中，慢性疼痛结果的调解人和主持人。
DOI：
10.1097/ajp.0000000000000125
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发表时间：
2015-05
期刊：
影响因子：
--
通讯作者：
Trudeau KJ
中科院分区：
文献类型：
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作者：
DasMahapatra P;Chiauzzi E;Pujol LM;Los C;Trudeau KJ
关于基于认知行为疗法（CBT）的在线疼痛干预措施的调节者和调节者的变化知之甚少。我们假设，painACTION.com（一种在线疼痛自我管理程序）对疼痛相关结局的影响将通过抑郁、焦虑和压力的变化以及应对策略的使用来介导。我们还研究了潜在的变化调节者。首先，使用来自先前背部、神经性和关节炎疼痛研究的合并样本来评估painACTION.com的功效和干预效果的调节剂。接下来，我们探讨了干预对主要结局-疼痛严重程度和患者总体变化印象（PGIC）的影响是否由应对策略或情绪功能介导。与对照组相比，从基线到随访，实验参与者在疼痛、情绪功能和应对策略方面均有显著改善。没有明确的干预效果的调节。随着时间的推移，情绪因素的变化，特别是压力水平，介导了干预和结果（疼痛严重程度）之间的关系。这项研究支持在线干预的有效性时，CBT和自我管理的目标疼痛水平，情绪因素和健康为重点的应对。压力作为疼痛严重程度的调解人的重要性进行了讨论。缺乏调节剂可能表明干预对各种慢性疼痛患者有效。
Little is known about the moderators and mediators of change in online pain interventions based on cognitive behavioral therapy (CBT). We hypothesized that the effects of painACTION.com, an online pain self- management program, on pain-related outcomes would be mediated by changes in depression, anxiety, and stress, as well as the use of coping strategies. We also examined potential moderators of change. First, the efficacy of painACTION.com and moderators of the intervention effects were evaluated using a pooled sample from previous back, neuropathic, and arthritis pain studies. Next, we explored whether the intervention effect on the primary outcomes - pain severity and patient global impression of change (PGIC) was mediated by coping strategies or emotional functioning. Compared to controls, experimental participants evidenced significant improvement in pain, emotional functioning, and coping strategies from baseline to follow-up. There were no clear moderators of intervention effects. Changes in emotional factors, particularly stress levels, mediated the relationship between the intervention and outcome (pain severity) over time. This study supports the effectiveness of online interventions when CBT and self-management targets pain levels, emotional factors and wellness-focused coping. The importance of stress as a mediator of pain severity is discussed. The absence of moderators may indicate that the intervention is effective for a wide variety of patients with chronic pain.