Mechanisms of Psychosocial Chronic Pain Treatments

描述（由申请人提供）：慢性腰痛是一个主要的公共卫生问题。社会心理疼痛干预措施已经激增，一些方法的有效性得到了强有力的支持。大多数研究都集中在这些治疗方法的总体疗效问题上。然而，关于这些心理疼痛治疗产生益处的机制的重要问题被忽视了。我们还没有从经验上确定心理疼痛治疗是如何起作用的。为了解决这一知识差距，我们需要将社会心理疼痛研究的注意力从仅仅评估治疗效果转向发现有效的核心治疗机制。我们提出并建议测试两种治疗机制的概念模型。首先，特定机制模型认为，不同的治疗主要通过特定于治疗的机制起作用。因此，从理论上讲，行为治疗（BT）通过改变行为应对方式对疼痛患者起作用，认知治疗（CT）通过改变认知内容起作用，正念减压疗法（MBSR）通过改变认知过程起作用。相比之下，第二种方法认为心理社会疼痛干预是有效的，因为它们都是通过一个或多个共享机制运作的，可以称为共享机制模型。这将包括由一种或多种特定理论和一般机制预示的机制，这些机制被认为是所有可行的社会心理干预（例如，治疗关系）所共有的因素。为了测试这两个模型的有效性，并确定心理社会疼痛治疗效果的关键机制，400名慢性腰痛患者将被随机分配到4种治疗方法中的一种：BT、CT、正念减压或疼痛教育控制条件。共举办8次会议，每次1.5小时。机制和结果措施将每周进行评估。我们将首先确定哪个模型-特定的和共享的-最好地解释数据。在支持共享机制模型的情况下，进一步的分析将确定哪种机制在整个治疗过程中是关键的。接下来，我们将评估除前后变化之外的机制的影响，并重点关注6-12个月的随访。对有益的前后结果产生影响的机制可能与对6-12个大多数维持和/或增强结果产生影响的机制相同。也可能是与前后结果变化没有强烈关联的机制可能成为6-12个大多数结果的重要预测因素。研究结果将为社会心理疼痛治疗起作用的原因提供重要的新线索。我们的研究项目或计划必须到目前为止。这些发现将增加对每一种假设机制对结果的因果影响的理解，从而揭示哪一种或多种机制应该是治疗程序和技术的主要目标。这将使我们确定在进一步的干预中我们是否应该把全部或大部分精力集中在改变慢性疼痛患者的行为上，他们的思想内容，他们对思想的反应，只是其中的两个，还是全部三个。

DESCRIPTION (provided by applicant): Chronic low back pain is a major public health concern. Psychosocial pain interventions have proliferated, and some approaches have strong support for efficacy. Most research has been focused on questions regarding the overall efficacy of these treatments. However, important questions regarding the mechanisms by which these psychosocial pain treatments produce benefits have been neglected. We have not yet empirically determined how psychosocial pain treatments work. Addressing this knowledge gap requires that we shift attention in psychosocial pain research away from evaluating only treatment efficacy and toward research that uncovers effective core treatment mechanisms. We advance and propose to test 2 conceptual models of treatment mechanisms. First, the Specific Mechanisms Model holds that different treatments work primarily via mechanisms specific to the treatment. Thus, Behavioral Treatment (BT) theoretically works in persons with pain via changes in behavioral coping, Cognitive Therapy (CT) works via changes in cognitive content, and MBSR works via changes in cognitive process. In contrast, a second approach holds that psychosocial pain interventions are effective because they all operate via 1 or more shared mechanisms, and can be termed the Shared Mechanisms Model. This would include mechanisms heralded by 1 or more of the specific theories and general mechanisms that are reputed to be factors held in common by all viable psychosocial interventions (e.g., therapeutic relationship). To test the validity of the 2 models and identify the mechanisms critical for the efficacy of psychosocial pain treatments, 400 people with chronic low back pain will be randomly assigned to 1 of 4 treatments: BT, CT, MBSR, or a Pain Education control condition. Eight sessions of 1.5 hrs duration will be delivered. Mechanism and outcome measures will be assessed weekly. We will first determine which model - specific vs. shared - best explains the data. In the event that the Shared Mechanism Model is supported, further analyses will determine which mechanism(s) is (are) critical across the treatments. Next, we will evaluate effects of mechanisms beyond pre-post changes and focus on 6-12 mos follow-up. It may be that the mechanisms showing effects on salutary pre-post outcomes will be the same mechanisms exerting effects on 6-12 mos maintenance and/or enhanced outcomes. It may also be that mechanisms not showing strong associations with pre-post outcome changes may emerge as important predictors of 6-12 mos outcomes. Results will shed important new light on what makes psychosocial pain treatments work. ous project or program of research has to date. Such findings will increase understanding of the causal impacts of each of the hypothesized mechanisms on outcomes, and so reveal which one or more mechanisms should be the primary target(s) of treatment procedures and techniques. This will allow us to determine whether in further interventions we should focus all or most of our efforts on changing what people with chronic pain do, the content of their thoughts, how they respond to their thoughts, just two of these, or all three.