Emotion regulation as a primary mechanism of action in yoga interventions for chronic low back pain: An RCT testing biological and psychological pathways

摘要 瑜伽已被证明在减轻疼痛和改善功能方面具有一致但适度的效果， 在多项随机对照试验中，慢性腰痛（CLBP）人群。审查和实践 指南支持瑜伽作为CLBP的循证治疗，至少有适度的益处， 作为一种综合疗法越来越多地被应用。然而，瑜伽发挥作用的机制 尚未确定疼痛严重程度和干扰的临床改善;这种识别可能导致 优化瑜伽干预措施以提高其效力。确定与下列因素相关的潜在机制： 瑜伽干预（PA 18-323），并基于瑜伽的综合理论情绪调节模型 由PI开发，我们的目标是测试情绪调节作为瑜伽效果的主要机制， 瑜伽对增加适应性情绪调节的影响可能通过生物途径起作用， 影响疼痛相关的功能情绪强烈影响疼痛强度的感知并预测残疾， 特别是在CLBP患者中，促进情绪调节技能的干预措施已经被广泛应用于临床。 可以减轻疼痛。越来越多的证据表明，持续的瑜伽练习可以促进改善 情绪调节，但研究尚未测试瑜伽练习对CLBP的影响是否是由于 改善情绪调节。为了研究这个问题，我们将进行一项随机对照试验， 204名CLBP患者在干预前、6周、干预后以及3个月和6个月随访时进行了评估 测试瑜伽干预对情绪调节的影响，相对于拉伸/加强， 冥想或呼吸法其次，我们还将评估瑜伽对CLBP（改善疼痛）的影响 严重性和功能）由情绪调节的变化介导。我们还研究了是否链接 情绪调节和疼痛严重程度之间的关系，以及疼痛敏感性调节或介导的功能， 已经被理论化和/或证明可以解释疼痛变化的效应，从而测试情绪 调节是瑜伽对CLBP临床作用的关键机制。

Abstract Yoga has been shown to have consistent but modest effects in reducing pain and improving function in populations with chronic low back pain (CLBP) in multiple randomized controlled trials. Reviews and practice guidelines support yoga as an evidence-based treatment for CLBP with at least moderate benefit and yoga is being increasingly applied as an integrative therapy. However, the mechanisms through which yoga exerts clinical improvements on pain severity and interference have not been identified; such identification might lead to optimizing yoga interventions to improve their potency. To identify underlying mechanisms associated with yoga interventions (PA 18-323) and based on a comprehensive theoretical emotion regulation model of yoga developed by the PI, we aim to test emotion regulation as a primary mechanism of yoga's effects, and to test biological pathways through which yoga's effects on increased adaptive emotion regulation may operate to affect pain-related functioning. Emotions strongly influence perceptions of pain intensity and predict disability, particularly among individuals with CLBP, and interventions that promote emotion regulation skills have been shown to reduce pain. Increasing evidence demonstrates that consistent yoga practice can promote improved emotion regulation, but research has not yet tested whether the effects of yoga practice on CLBP are due to improvements in emotion regulation. To examine this issue, we will conduct a randomized controlled trial of 204 people with CLBP assessed pre-intervention, 6 weeks, post-intervention and at 3- and 6-month follow-up to test the impact of a yoga intervention on emotion regulation relative to stretching/strengthening without meditation or breathwork. Secondarily, we will also assess whether yoga's effects on CLBP (improved pain severity and functioning) are mediated by changes in emotion regulation. We also examine whether the link between emotion regulation and pain severity and functioning is moderated or mediated by pain sensitization, effects that have been theorized and/or demonstrated to account for changes in pain, thereby testing emotion regulation as a key mechanism underlying the clinical effects of yoga on CLBP.