Comparison of Cognitive Treatments for Headache Pain

申请人？认知行为干预是一种有效的 疼痛问题患者的多学科治疗的组成部分。的 治疗成功的关键因素尚不清楚，也不清楚 为什么CBT对某些患者比其他人更有效。很少有研究 评估了CBT特定成分对疼痛的效用， CBT的认知成分的比较尤其缺乏。第一 本研究的目的是进行两种随机对照比较， 认知行为干预对延迟治疗头痛的影响 对照组所采用的两种认知干预将是治疗 专注于减少疼痛特异性功能失调的认知， 治疗的重点是教授认知应对策略 研究将由当地神经科医生转诊，并符合诊断标准 治疗偏头痛和/或紧张型头痛全面评估将 在治疗前和治疗8周后进行（主要 端点）。主要结局指标将包括：自我报告的疼痛强度 以及头痛和止痛药的使用频率。次要结局变量 将包括抑郁，焦虑，思维障碍， 灾难化、认知应对和自我效能。据预测 接受治疗的患者将显示出显著的治疗收益， 延迟治疗组。然而，预计认知 重组将带来更大的治疗收益，而不是应对技能 训练本研究的第二个目的是检验 灾难化，一个特定的个体变量，已被证明可以预测 疼痛治疗成功。在以下方面得分高的人 灾难化的人表现出更差的生理和心理功能。这些 个体对治疗的反应也较差。它是假设 基线灾难性评分将是治疗成功的预测因子。 在灾难化程度上得分较高的参与者表现得更少 比那些在这方面得分较低的人更好。然而，在这方面， 灾难制造者的认知能力会有更大的相对改善， 而不是应对技能培训。未来的研究将考虑 结合这些治疗的潜在影响以及 组件介绍的顺序。

APPLICANT?S DESCRIPTION: Cognitive-behavioral interventions are an effective component of multidisciplinary treatment for patients with pain problems. The critical components for treatment success are not known, nor is it understood why CBT works better for some patients than for others. Very few studies have evaluated the utility of specific components of CBT for pain, and the comparison of cognitive components of CBT is particularly lacking. The first aim of this study is to conduct a randomized control comparison of two cognitive-behavioral interventions for headache pain to a delayed treatment control group. The two cognitive interventions employed will be treatment focused on the reduction of pain-specific dysfunctional cognitions and treatment focused on teaching cognitive coping strategies Participants in this study will be referred by local neurologists and will meet diagnostic criteria for migraine and/or tension-type headache. Comprehensive assessments will be conducted before treatment and following 8 weeks of treatment (primary endpoint). Primary outcome measures will include: self-reported pain intensity and frequency of headaches and pain medication use. Secondary outcome variables will include measures of depression, anxiety, dysfunctional thinking, catastrophizing, cognitive coping and self-efficacy. It is predicted that patients who receive treatment will show significant treatment gains compared to the delayed treatment group. However it is expected that cognitive restructuring will result in greater treatment gains than coping skills training. The second aim of the study is to examine the effect of catastrophizing, a specific individual variable that has been shown to predict pain treatment success. Individuals who score high on measures of catastrophizing display poorer physical and psychosocial functioning. These individuals also evidence poorer response to treatment. It is hypothesized that baseline catastrophizing scores will be a predictor of treatment success. Participants who score higher on a measure of catastrophizing will show less improvement than individuals who score lower on this measure. However, catastrophizers will show greater relative improvement with cognitive restructuring than with coping skills training. Future research will consider the potential effects of combining these treatments as well as the impact of order of component presentation.