Explaining symptom severity, distress and disability in chronic pain: The role of mental defeat

慢性疼痛是一个全球性的健康问题，影响着英国约800万人。虽然看不见，但它对人们的日常活动、身体健康和心理健康的影响是非常明显和深远的。研究表明，慢性疼痛是每年超过400万GP预约的原因，慢性疼痛的存在使抑郁和自杀的风险增加了两到三倍。大多数慢性疼痛病例没有特定的已知原因，因此不可能治愈。因此，帮助人们在慢性疼痛的情况下生活得更好是疼痛管理计划的最终目标，尽管这些心理干预的效果令人沮丧地温和。确定解释症状严重程度的进展并预测自我管理的发展或崩溃的心理因素将为推进这些治疗提供重要线索。现有的慢性疼痛的心理干预通常集中在症状管理上，忽视了慢性疼痛对人的更深层次的自我意识和身份的影响。我们小组的工作发现，那些因慢性疼痛而最痛苦和残疾的人往往有一种强烈的精神挫败感，以至于他们觉得他们已经失去了与慢性疼痛的重要战斗。这种失败的精神状态的特点是感觉失去了自主性，社会地位和人类的完整性。心理挫败的概念与抑郁症、创伤后应激障碍和自杀的解释有关。它可以被测量，我们有初步的证据表明，与心理过程相比，精神失败可以更好地解释疼痛干扰和寻求专业疼痛治疗（例如，疼痛灾难化）是当前治疗的目标。拟议的研究将提供一个深入的调查的作用，精神挫折的发展症状，痛苦和残疾与慢性疼痛。这项研究有三个方法上互补的组成部分。具体而言，我们将在实验室中进行严格控制的实验，问卷调查研究和参与者自然生活环境中的经验抽样研究，为期一年。总之，这些将产生第一个必要的实验和纵向证据：目标1 -评估当精神挫败感被激活时疼痛反应如何改变，目标2 -确定6个月和12个月内精神挫败与身体，心理和社会结果相关的程度，目标3 -描绘潜在的日常过程，如注意力，情绪，压力，身体和社会活动、睡眠和使用药物，通过这些，精神上的失败会加重症状，并转化为痛苦和残疾的根源。拟议的研究旨在为治疗开发提供信息，并将与慢性疼痛患者一起进行，以最大限度地提高其临床相关性。早期的研究慢性疼痛的心理失败是有限的，由于可以理解的伦理问题和缺乏可行的实验方案，他们的定性和相关性的性质。这项拟议中的研究将应用我们小组成功开发的思想操纵技术，暂时激活与疼痛相关的精神挫败感，而不会给参与者造成不必要的痛苦。它还将利用数据监测和分析技术，该集团是众所周知的，以评估心理失败和结果之间的时间关系的兴趣在真实的世界从病人的角度。研究结果将对未来慢性疼痛的心理学理论产生影响，并为更广泛地了解慢性疼痛及其密切相关的疾病（包括抑郁症，创伤后应激障碍和自杀）开辟令人兴奋的途径。

Chronic pain is a global health problem that affects around 8 million people in the UK. Although it cannot be seen, its impact on people's day-to-day activities, physical health and psychological wellbeing is highly visible and far-reaching. Research has shown that chronic pain is the reason for >4 million GP appointments each year and that the presence of chronic pain raises the risk of depression and suicide by two to three times. Most cases of chronic pain do not have a specific known cause, and hence are impossible to cure. Helping people to live well despite chronic pain is therefore the ultimate goal of pain management programmes, although the effect of these psychological interventions has been frustratingly modest. Identifying the psychological factor that explains the progression of symptom severity and predicts the development of distress or breakdown of self-management will offer important clues to advancing these treatments. Existing psychological interventions for chronic pain typically focus on symptom management, overlooking the impact of chronic pain on the person's deeper sense of self and identity. Work by our group has discovered that people who are most distressed and disabled by chronic pain tend to have a strong sense of mental defeat, such that they feel that they have lost an important battle with chronic pain. Such defeated state of mind is characterised by a perceived loss of autonomy, social rank and human integrity. The concept of mental defeat is relevant to the explanation of depression, post-traumatic stress disorder and suicide. It can be measured and we have initial evidence to suggest that mental defeat can better explain pain interference and the seeking of specialist pain treatment, compared to psychological processes (e.g., pain catastrophising) targeted by current treatments. The proposed research will provide an in-depth investigation of the role of mental defeat in the development of symptoms, distress and disability associated with chronic pain. The research has three methodologically complementary components. Specifically, we will carry out a tightly-controlled experiment in the laboratory, a questionnaire study and an experience sampling study in the participant's natural living environment over the course of a year. Together, these will generate the first experimental and longitudinal evidence necessary to: Aim 1 - evaluate how pain responses are altered when the sense of mental defeat is activated, Aim 2 - determine the extent to which mental defeat is associated with physical, psychological and social outcomes in 6 and 12 months, and Aim 3 - delineate the potential day-to-day processes, such as attention, mood, stress, physical and social activity, sleep and use of medication, through which mental defeat aggravates symptoms and translates into a source of distress and disability. The proposed research aims to inform treatment development and will be carried out with people living with chronic pain to maximise its clinical relevance. Earlier research on mental defeat in chronic pain was limited by their qualitative and correlational nature due to understandable ethical concerns and a lack of viable experimental protocol. The proposed research will apply a thought manipulation technique successfully developed by our group to temporarily activate a pain-related sense of mental defeat without causing undue distress to the participants. It will also capitalise on data monitoring and analytic techniques the group is known for, to evaluate the temporal relationship between mental defeat and outcomes of interest in the real world from the patient's perspective. Findings of the research will have a bearing on future psychological theories of chronic pain and open up exciting avenues for a broader understanding of chronic pain and its closely aligned ailments, including depression, post-traumatic stress and suicide.