Comparative Mechanisms (Mediators, Moderators) of Psychosocial Chronic Pain Treatments

慢性肌肉骨骼疼痛(CP)是一个主要的公共卫生问题。一些心理社会治疗 近几十年来出现了帮助解决这一问题的机构。这些干预措施已被证明是 与基本惰性的控制条件相比是有效的；然而，最近的荟萃分析表明 大多数这些治疗的特点是对主要结果影响不大。这是一个关键的 这些本来很有希望的方法的缺点。而不是试图通过以下方式提高疗效 开发新的、有希望更强大的干预措施，我们还可以审视我们已经证明的 关于提高治疗效果大小的方法。一种策略是增加我们的 对治疗调解人的理解。需要对调解人的研究直接比较不同的 相互处理，以确定哪些介体是特定于治疗的，这些介体在 治疗，以及对临床结果贡献最大的治疗。这类研究的结果可以用来 告知对现有治疗的适应，以增强其益处。第二个战略是增加 现有治疗的有益效果是确定适度治疗的患者特征 回应。需要以理论模型为指导的研究，并测试多个 治疗。确定对一种或另一种治疗更有可能有效的患者亚组可以取得进展 通过事先告知患者治疗匹配的精准医学，可以优化治疗效果。我们会 比较认知行为疗法(CBT)、接受疗法和行为疗法的机制和调节因子 承诺疗法(ACT)和情绪意识与表达疗法(EAET)。检查 这些治疗的调解人和调解人在促进治疗发展和 提高治疗效果。患有慢性脊椎(轴性)疼痛的成年人(N=460)将被随机分配到CBT， ACT、EAET和照常治疗(TAU)。目标1是确定特定的和共享的调解人 治疗。目标2是确定不同处理的主持人。这个项目可以增加我们的 通过确定最有效的治疗机制-特定和 共享--并揭示了对于谁来说，调解人结果路径是最强的。通孔增加 了解调节剂和调节剂，可以开发更有效的疼痛治疗方法， 经过测试和实施。

Chronic musculoskeletal pain (CP) is a major public health concern. A number of psychosocial treatments have emerged in recent decades to help address this problem. These interventions have been shown to be efficacious when compared to largely inert control conditions; however, recent meta-analyses indicate that most of these treatments are characterized by modest effects on primary outcomes. This is a critical shortcoming of these otherwise promising approaches. Rather than attempting to boost efficacy only by developing new and hopefully more powerful interventions, we can also look within our already proven treatments for ways to enhance the magnitude of treatment effects. One strategy is to increase our understanding of treatment mediators. Studies of mediators are needed that directly compare different treatments with each other to determine which mediators are treatment-specific, which are shared across treatments, and which contribute the most to clinical outcomes. The findings from such research could be used to inform adaptations to existing treatment that enhance their benefits. A second strategy for increasing the beneficial effects of existing treatments is to identify the patient characteristics that moderate treatment responses. Research is needed that is guided by theoretical models and that tests moderators across multiple treatments. Identifying subgroups of patients more likely to respond to one or another treatment can advance precision medicine by informing a priori patient-treatment matches that can optimize treatment effects. We will compare the mechanisms and moderators of Cognitive-Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Emotional Awareness and Expression Therapy (EAET). Examining the mediators and moderators of these treatments holds great potential for advancing treatment development and enhancing treatment efficacy. Adults with chronic spinal (axial) pain (N=460) will be randomly assigned to CBT, ACT, EAET and to treatment-as-usual (TAU). Aim 1 is to identify specific and shared mediators across treatments. Aim 2 is to identify moderators across treatments. This project can increase the effects of our psychosocial chronic pain treatments by identifying the most powerful treatment mechanisms – specific and shared -- and revealing for whom the mediator  outcome pathways are strongest. Via increased understanding of mediator and moderators, more effective pain treatment approaches can be developed, tested, and implemented.