Behavioral Interventions for Low Back Pain

腰痛的行为干预

• 批准号: 6964777
• 负责人: STEVEN Z GEORGE
• 金额: $ 7.28万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6964777
• 关键词: avoidance behavior; backache; behavior modification; behavior therapy; behavioral /social science research tag; behavioral medicine; belief; clinical research; clinical trials; data collection methodology /evaluation; exercise; fear; human subject; human therapy evaluation; longitudinal human study; outcomes research; questionnaires; rehabilitation; social psychology

DESCRIPTION (provided by applicant). The dominant role that psychosocial factors play in the development of chronic disability from low back pain has been well established in the literature. As a result, the investigation of biopsychosocial models for treatment of low back pain has been advocated by researchers. The Fear-Avoidance Model of Exaggerated Pain Perception (FAMEPP) is a biopsychosocial model that proposes an individual's pain related fear and avoidance is the most important factor in determining whether chronic disability results from an episode of low back pain. In the FAMEPP, individuals with high pain related fear and avoidance are hypothesized to use an avoidance response to low back pain and have deleterious physical and psychological consequences. Individuals with low pain related fear and avoidance are hypothesized to use a confrontation response to low back pain and gradually return to their normal social and physical functioning. Support for the validity of the FAMEPP is found in longitudinal studies that have demonstrated that pain related fear and avoidance significantly predicts future disability after a low back injury. Treatment based on the FAMEPP involves facilitating confrontation in individuals that normally would not use a confrontation response (i.e. those with high pain related fear and avoidance). Two specific behavioral interventions have been used to facilitate confrontation for patients with low back pain. Graded exposure facilitates confrontation by systematically exposing the individual to situations that they are fearful of and gradually increasing their exposure to such situations. Graded exercise facilitates confrontation by systematically increasing the patients' tolerance to activity (graded exercise). Investigations in the literature support the use of these behavioral interventions, but their effectiveness has not been investigated in patients before they have chronic low back pain. Behavioral interventions that effectively reduce future disability before the onset of chronic symptoms could potentially reduce societal and economic costs associated with low back pain. The purpose of this small grant (RO3) research proposal is to determine the efficacy of a graded exposure rehabilitation intervention for reducing future disability from sub-acute low back pain for patients with elevated fear-avoidance beliefs.

描述（由申请人提供）。 在文献中已经确立了心理因素在从腰痛的慢性残疾发展中发挥的主要作用。结果，研究人员提倡对生物心理社会模型治疗下背部疼痛的研究。夸张的疼痛感知（FAMEPP）的避免恐惧模型是一种生物心理社会模型，它提出与个人的疼痛相关的恐惧和回避是确定慢性残疾是否是由于下背部疼痛发作而导致慢性残疾的最重要因素。在Famepp中，假设患有高疼痛相关的恐惧和回避的人会避免对腰痛的反应，并产生有害的身体和心理后果。假设患有低疼痛相关的恐惧和回避的人使用对腰痛的对抗反应，并逐渐恢复其正常的社会和身体机能。在纵向研究中发现了对Famepp的有效性的支持，这些研究表明，与疼痛相关的恐惧和避免症状可显着预测下背部损伤后的未来残疾。基于FAMEPP的治疗涉及促进个人通常不会使用对抗反应的个人（即那些与疼痛相关的恐惧和回避的人）。已经使用了两种特定的行为干预措施来促进腰痛患者的对抗。分级暴露是通过系统地将个人暴露于他们担心并逐渐增加对这种情况的情况的情况来促进对抗的。分级运动通过系统地增加患者对活动的容忍度（分级运动）来促进对抗。文献中的调查支持这些行为干预措施的使用，但是在患者患有慢性下腰痛之前，尚未对其有效性进行研究。在慢性症状发作之前有效减少未来残疾的行为干预措施可能会减少与下背痛有关的社会和经济成本。这项小额赠款（RO3）研究建议的目的是确定分级暴露康复干预措施的功效，以减少避免恐惧信念的患者减少亚急性下腰痛的未来残疾。