Explaining symptom severity, distress and disability in chronic pain: The role of mental defeat

解释慢性疼痛的症状严重程度、痛苦和残疾：精神挫败的作用

• 批准号: MR/S026185/1
• 负责人: Nicole Tang
• 金额: $ 72.89万
• 依托单位: University of Warwick
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FS026185%2F1
• 关键词: Explaining; symptom; severity; distress; disability

Chronic pain is a global health problem that affects around 8 million people in the UK. Although it cannot be seen, its impact on people's day-to-day activities, physical health and psychological wellbeing is highly visible and far-reaching. Research has shown that chronic pain is the reason for >4 million GP appointments each year and that the presence of chronic pain raises the risk of depression and suicide by two to three times. Most cases of chronic pain do not have a specific known cause, and hence are impossible to cure. Helping people to live well despite chronic pain is therefore the ultimate goal of pain management programmes, although the effect of these psychological interventions has been frustratingly modest. Identifying the psychological factor that explains the progression of symptom severity and predicts the development of distress or breakdown of self-management will offer important clues to advancing these treatments. Existing psychological interventions for chronic pain typically focus on symptom management, overlooking the impact of chronic pain on the person's deeper sense of self and identity. Work by our group has discovered that people who are most distressed and disabled by chronic pain tend to have a strong sense of mental defeat, such that they feel that they have lost an important battle with chronic pain. Such defeated state of mind is characterised by a perceived loss of autonomy, social rank and human integrity. The concept of mental defeat is relevant to the explanation of depression, post-traumatic stress disorder and suicide. It can be measured and we have initial evidence to suggest that mental defeat can better explain pain interference and the seeking of specialist pain treatment, compared to psychological processes (e.g., pain catastrophising) targeted by current treatments. The proposed research will provide an in-depth investigation of the role of mental defeat in the development of symptoms, distress and disability associated with chronic pain. The research has three methodologically complementary components. Specifically, we will carry out a tightly-controlled experiment in the laboratory, a questionnaire study and an experience sampling study in the participant's natural living environment over the course of a year. Together, these will generate the first experimental and longitudinal evidence necessary to: Aim 1 - evaluate how pain responses are altered when the sense of mental defeat is activated, Aim 2 - determine the extent to which mental defeat is associated with physical, psychological and social outcomes in 6 and 12 months, and Aim 3 - delineate the potential day-to-day processes, such as attention, mood, stress, physical and social activity, sleep and use of medication, through which mental defeat aggravates symptoms and translates into a source of distress and disability. The proposed research aims to inform treatment development and will be carried out with people living with chronic pain to maximise its clinical relevance. Earlier research on mental defeat in chronic pain was limited by their qualitative and correlational nature due to understandable ethical concerns and a lack of viable experimental protocol. The proposed research will apply a thought manipulation technique successfully developed by our group to temporarily activate a pain-related sense of mental defeat without causing undue distress to the participants. It will also capitalise on data monitoring and analytic techniques the group is known for, to evaluate the temporal relationship between mental defeat and outcomes of interest in the real world from the patient's perspective. Findings of the research will have a bearing on future psychological theories of chronic pain and open up exciting avenues for a broader understanding of chronic pain and its closely aligned ailments, including depression, post-traumatic stress and suicide.

慢性疼痛是一个全球性的健康问题，影响着英国约800万人。虽然看不见，但它对人们日常活动、身体健康和心理健康的影响是非常明显和深远的。研究表明，慢性疼痛是每年400万家庭医生就诊的原因，慢性疼痛的存在使抑郁和自杀的风险增加了两到三倍。大多数慢性疼痛病例没有明确的已知原因，因此不可能治愈。因此，尽管这些心理干预的效果令人沮丧，但帮助人们在慢性疼痛的情况下生活得更好是疼痛管理规划的最终目标。确定解释症状严重程度进展的心理因素，并预测痛苦或自我管理崩溃的发展，将为推进这些治疗提供重要线索。现有的慢性疼痛心理干预通常侧重于症状管理，忽视了慢性疼痛对人的深层自我意识和身份的影响。我们小组的工作发现，那些被慢性疼痛折磨得最痛苦和残疾的人往往有一种强烈的精神挫败感，以至于他们觉得自己输掉了一场与慢性疼痛的重要战斗。这种失败的心理状态的特点是感觉到自主权、社会地位和人格完整性的丧失。心理失败的概念与抑郁症、创伤后应激障碍和自杀的解释有关。它是可以测量的，我们有初步的证据表明，与目前治疗针对的心理过程（例如，疼痛灾难）相比，心理失败可以更好地解释疼痛干扰和寻求专业疼痛治疗。拟议的研究将提供一个深入的调查心理失败的作用，在发展的症状，痛苦和残疾与慢性疼痛相关。这项研究在方法论上有三个互补的组成部分。具体来说，我们将在一年的时间里，在实验室进行严格控制的实验，在参与者的自然生活环境中进行问卷调查研究和经验抽样研究。总之，这些将产生第一个必要的实验和纵向证据，以便：目标1 -评估当精神挫败感被激活时，疼痛反应是如何改变的；目标2 -确定精神挫败在多大程度上与6个月和12个月的身体、心理和社会结果相关；目标3 -描述潜在的日常过程，如注意力、情绪、压力、身体和社会活动、睡眠和药物使用，通过这些过程，精神挫败会加重症状，并转化为痛苦和残疾的来源。拟议的研究旨在为治疗开发提供信息，并将与慢性疼痛患者一起进行，以最大限度地提高其临床相关性。由于可以理解的伦理问题和缺乏可行的实验方案，早期关于慢性疼痛中心理失败的研究受到定性和相关性的限制。本研究将采用我们小组成功开发的思想操纵技术，暂时激活与疼痛相关的精神挫败感，而不会给参与者造成不必要的痛苦。它还将利用该组织闻名的数据监测和分析技术，从患者的角度评估精神失败与现实世界中感兴趣的结果之间的时间关系。这项研究的发现将对未来慢性疼痛的心理学理论产生影响，并为更广泛地了解慢性疼痛及其密切相关的疾病（包括抑郁症、创伤后应激障碍和自杀）开辟令人兴奋的途径。

项目成果

An exploratory investigation into the effects of mental defeat on pain threshold, pain rating, pain anticipation, and mood

• DOI: 10.1007/s12144-021-01548-3
• 发表时间: 2021-03-10
• 期刊: CURRENT PSYCHOLOGY
• 影响因子: 2.8
• 作者: Collard, Victoria E. J.;Gillett, Jenna L.;Tang, Nicole K. Y.
• 通讯作者: Tang, Nicole K. Y.

Mental Defeat and Suicidality in Chronic Pain: A Prospective Analysis.

慢性疼痛中的精神挫败和自杀：前瞻性分析。

• DOI: 10.1016/j.jpain.2023.06.017
• 发表时间: 2023
• 期刊: The journal of pain
• 作者: Themelis K

Investigating mental defeat in individuals with chronic pain: Protocol for a longitudinal experience sampling study.

• DOI: 10.1136/bmjopen-2022-066577
• 发表时间: 2023-02-06
• 期刊: BMJ open
• 影响因子: 2.9

Cover Overlapping Pain and Psychiatric Syndromes: Global Perspectives

涵盖重叠疼痛和精神综合症：全球视角

• 发表时间: 2020
• 作者: Cheatle, Martin D., Foster, Simmie, Tang, Nicole KY

Cognitive factors and processes in models of insomnia: A systematic review.

失眠模型中的认知因素和过程：系统评价。

• DOI: 10.1111/jsr.13923
• 发表时间: 2023
• 期刊: Journal of sleep research
• 影响因子: 4.4
• 作者: Tang NKY