Treatment Outcomes and Mechanisms for an ACT-Based 10-Week Interdisciplinary Chronic Pain Rehabilitation Program
Treatment Outcomes and Mechanisms for an ACT-Based 10-Week Interdisciplinary Chronic Pain Rehabilitation Program
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DOI：
10.1111/papr.12824
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发表时间：
2019-09-12
期刊：
影响因子：
2.6
通讯作者：
George, Logan L.
中科院分区：
文献类型：
--
作者：
Craner, Julia R.;Lake, Eric S.;George, Logan L.
背景：跨学科疼痛康复计划是一种针对慢性疼痛的循证生物心理社会治疗方法。本研究的目的是评估为期10周的基于跨学科、接受和承诺治疗(ACT)的门诊治疗模式的结果，并评估心理过程变量(即疼痛灾变、疼痛接受、疼痛自我效能)与治疗结果之间的关系。方法137例成人慢性疼痛患者完成跨学科疼痛康复计划。在入院和出院时完成疼痛、疼痛干预、健康相关生活质量、焦虑、抑郁情绪、失眠、疼痛灾难、疼痛接受和疼痛自我效能的测量。还收集了人口统计学和临床变量的数据，包括阿片类药物的使用。结果与入院时相比，出院时各项指标均有显著变化。阿片类药物的剂量也减少了。受试者内冥想分析的结果表明，疼痛灾变在疼痛严重程度、疼痛干扰和抑郁情绪的治疗效果中占很大比例。疼痛接受是抑郁情绪改变的中介变量，而疼痛自我效能是疼痛干预结果的中介变量。结论本研究支持基于ACT的跨学科慢性疼痛康复治疗模式，为期10周。此外，疼痛灾变、疼痛接受和疼痛自我效能都被发现是个体获得成功治疗结果的机制。这项研究为慢性疼痛的跨学科康复方法提供了进一步的支持。
Background Interdisciplinary pain rehabilitation programs are an evidence-based biopsychosocial treatment approach for chronic pain. The purpose of the current study is to assess outcomes for a 10-week interdisciplinary, acceptance and commitment therapy (ACT)-based, outpatient treatment model and to evaluate the relationship between psychological process variables (ie, pain catastrophizing, pain acceptance, pain self-efficacy) and treatment outcomes. Methods 137 adults with chronic pain completed an interdisciplinary pain rehabilitation program. Measures of pain, pain interference, health-related quality of life, anxiety, depressed mood, insomnia, pain catastrophizing, pain acceptance, and pain self-efficacy were completed at admission and discharge. Data were also collected on demographic and clinical variables, including opioid use. Results Results indicated significant changes in all measures at program discharge compared to admission. Opioid doses were also reduced. Results of within-subjects meditational analyses indicated that pain catastrophizing accounted for a significant portion of the treatment effect for pain severity, pain interference, and depressed mood. Pain acceptance was a mediator for change in depressed mood, whereas pain self-efficacy was a mediator for pain interference outcomes. Conclusions This study supports a 10-week, ACT-based treatment model for interdisciplinary chronic pain rehabilitation. In addition, pain catastrophizing, pain acceptance, and pain self-efficacy were each found to be mechanisms by which individuals achieve successful treatment outcomes. This research provides further support for interdisciplinary rehabilitation approaches for chronic pain.