Fibromyalgia: Interventions for pain and mood regulation

描述（由申请人提供）：大约5%的女性和1.6%的男性（White et al., 1999）被诊断为纤维肌痛（FM），这是一种病因不明的慢性疼痛，几乎没有令人满意的治疗方案。FM的特点是广泛的疼痛，睡眠障碍和疲劳，经常导致广泛的功能限制。虽然最广泛使用的慢性疼痛心理干预，认知行为疗法（CBT），已经成功地解决了疼痛管理，但它并没有直接解决FM患者面临的情绪调节的独特挑战。积极和消极情绪调节的缺陷是FM患者临床表现的显著特征。一种综合的方法，通过关注改善情感调节缺陷来加强CBT在疼痛管理方面的治疗效果，不仅有可能提高我们对情感在慢性疼痛中的作用的认识，而且还提供了一种经验验证的治疗选择，目前尚无法用于FM。这项拨款提议测试一种认知行为治疗FM的有效性，这种治疗通过针对情绪调节来补充现有治疗的疼痛管理重点。两个焦点是情绪调节组件的核心：1)最小化复发性疼痛的负面情感后果，包括抑郁和焦虑症状；2)尽管疼痛，但保持积极情感的关键来源。FM患者（N=180）将被随机分配到三种治疗中的一种：疼痛认知行为治疗（CBT-P），疼痛和情绪调节认知行为治疗（CBT-PE），或仅教育对照组（EC）。干预前和干预后评估将包括对疼痛和自然压力源的认知、情感和行为反应的日间现场记录，并辅以对标准化疼痛和情感刺激的实验室反应测试。与EC相比，CBT-P和CBT-PE都有望改善疼痛管理，但CBT-PE有望产生更广泛的影响，通过增加积极的情感参与和减少对疼痛和压力的反应来改善身体和心理功能。因此，与CBT-P和EC组相比，CBT-PE应该增强FM患者应对疾病压力方面和生活其他方面的能力，从而对功能健康和福祉产生更有益的长期影响。

DESCRIPTION (provided by applicant): Approximately 5% of women and 1.6% of men (White et al., 1999) have been diagnosed with Fibromyalgia (FM), a chronic pain condition of unknown etiology with few satisfactory treatment options. FM is characterized by widespread pain, sleep disturbance, and fatigue that frequently lead to extensive functional limitations. Although the most widely used psychological intervention for chronic pain, cognitive behavioral therapy (CBT), has successfully addressed pain management, it has not directly addressed the distinct challenges to emotion regulation faced by FM patients. Deficits in positive and negative affect regulation are salient features of the clinical profile of FM patients. An integrated approach that fortifies the therapeutic gains in pain management provided by CBT with attention to ameliorating affective regulation deficits has the potential not only to advance our knowledge of the role of emotion in chronic pain but also to provide an empirically validated treatment option not currently available for FM. This grant proposes to test the effectiveness of a cognitive-behavioral treatment for FM that supplements the pain management emphasis of existing treatments by also targeting emotion regulation. Two foci are central to the emotion regulation component: 1) minimizing the negative affective consequences of recurrent pain, including depression and anxiety symptoms, and 2) sustaining key sources of positive affect in spite of pain. FM patients (N=180) will be randomly assigned to one of three treatments: Cognitive-Behavior Therapy for Pain (CBT-P), Cognitive-Behavior Therapy for Pain and Emotion Regulation (CBT-PE), or an Education-Only Control Group (EC). Pre- and post-intervention assessments will include within-day field records of cognitive, affective, and behavioral responses to pain and naturalistic stressors, complemented by laboratory-based tests of reactivity to standardized pain and affective stimuli. Both CBT-P and CBT-PE are expected to improve pain management relative to EC, but CBT-PE is expected to have a broader impact, improving physical and psychological functioning by increasing positive affective engagement and decreasing reactivity to pain and stress. Thus, CBT-PE should enhance the capacity of FM patients to cope with stressful aspects of their illness and other areas of their lives, leading to more beneficial long-term effects on functional health and well being compared to CBT-P and EC groups.