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

社会心理慢性疼痛治疗的比较机制（中介、调节因素）

• 批准号: 10810951
• 负责人: John W. Burns
• 金额: $ 26.15万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10810951
• 关键词: Address; Adult; Advisory Committees; Alexithymias; Awareness; Back; Behavioral; Belief; Brain; Characteristics; Chronic; Clinical; Cognitive Therapy; Compassion; Emotional; Event; Intervention; Mediating; Mediator; Meta-Analysis; Modeling; Neck; Outcome; Pain; Pain management; Pathway interactions; Patients; Persons; Predictive Factor; Process; Proliferating; Public Health; Randomized; Recommendation; Recording of previous events; Reporting; Research; Scientist; Spinal; Spine pain; Testing; Theoretical model; Therapeutic; Trauma; Treatment Efficacy; Vertebral column; Work; chronic musculoskeletal pain; chronic pain management; comparative; comparative trial; coping; improved; improved outcome; innovation; novel strategies; pain catastrophizing; patient subsets; precision medicine; primary outcome; psychosocial; theories; therapy development; treatment as usual; treatment effect; treatment optimization; treatment response; virtual

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.

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 近几十年来出现的解决这个问题的方法。这些干预措施已被证明是 与很大程度上惰性的控制条件相比是有效的；然而，最近的荟萃分析表明 大多数治疗的特点是对主要结果影响不大。这是一个关键的 这些原本很有前途的方法的缺点。而不是仅仅尝试通过 开发新的、希望更强大的干预措施，我们也可以审视我们已经证实的 治疗方法以增强治疗效果的程度。一项策略是增加我们的 对治疗中介的了解。需要对中介因素进行研究，直接比较不同的中介因素 相互进行治疗以确定哪些调节剂是治疗特异性的，哪些是跨组共享的 治疗，并且对临床结果贡献最大。此类研究的结果可用于 为现有治疗方法的调整提供信息，以增强其益处。第二个策略是增加 现有治疗的有益效果是确定调节治疗的患者特征 回应。需要以理论模型为指导并测试多个调节器的研究 治疗。确定更有可能对一种或另一种治疗产生反应的患者亚组可以推进 精准医学通过告知先验的患者治疗匹配来优化治疗效果。我们将 比较认知行为疗法 (CBT)、接受和治疗的机制和调节因素 承诺疗法（ACT）和情绪意识和表达疗法（EAET）。检查 这些治疗的中介者和调节者在推进治疗开发和 提高治疗效果。患有慢性脊柱（轴向）疼痛的成年人 (N=460) 将被随机分配接受 CBT， ACT、EAET 和照常治疗 (TAU)。目标 1 是确定跨领域的特定和共享调解者 治疗。目标 2 是确定不同治疗方法的调节因素。这个项目可以增加我们的影响 通过确定最有效的治疗机制（具体和有效）来治疗心理社会慢性疼痛 共享——并揭示对谁来说调解者→结果路径是最强的。通过增加 了解中介者和调节者，可以开发更有效的疼痛治疗方法， 测试并实施。