Behavioral Interventions for Low Back Pain

描述(由申请人提供)。 心理社会因素在慢性腰痛致残发展中的主导作用已在文献中得到很好的证实。因此，研究人员一直倡导研究治疗下腰痛的生物-心理-社会模型。夸大疼痛感知的恐惧回避模型(FAMEPP)是一种生物心理社会模型，它提出个人与疼痛相关的恐惧和回避是决定慢性残疾是否源于一次下腰痛发作的最重要因素。在FAMEPP中，与疼痛相关的高度恐惧和回避的个人被假设为对下腰痛使用回避反应，并产生有害的身体和心理后果。与疼痛相关的恐惧和回避程度较低的个体被假设为对下腰痛做出对抗反应，并逐渐恢复正常的社会和身体功能。在纵向研究中发现了对FAMEPP有效性的支持，这些研究表明，与疼痛相关的恐惧和回避显着预测下腰损伤后未来的残疾。基于FAMEPP的治疗包括促进通常不会使用对抗反应的个人(即那些具有高度疼痛相关恐惧和回避的人)的对抗。已经使用了两种特定的行为干预来促进下腰痛患者的对抗。通过系统地将个人暴露在他们害怕的情况下并逐渐增加他们对这种情况的暴露，分级暴露促进了对抗。分级锻炼通过系统地增加患者对活动的耐受性(分级锻炼)来促进对抗。文献中的研究支持这些行为干预措施的使用，但在患者出现慢性下腰痛之前，尚未对其有效性进行调查。在慢性症状出现之前有效减少未来残疾的行为干预可能会降低与下腰痛相关的社会和经济成本。这项小额拨款(R03)研究建议的目的是确定分级暴露康复干预对提高恐惧回避信念的患者减少亚急性下腰痛未来残疾的有效性。

DESCRIPTION (provided by applicant). The dominant role that psychosocial factors play in the development of chronic disability from low back pain has been well established in the literature. As a result, the investigation of biopsychosocial models for treatment of low back pain has been advocated by researchers. The Fear-Avoidance Model of Exaggerated Pain Perception (FAMEPP) is a biopsychosocial model that proposes an individual's pain related fear and avoidance is the most important factor in determining whether chronic disability results from an episode of low back pain. In the FAMEPP, individuals with high pain related fear and avoidance are hypothesized to use an avoidance response to low back pain and have deleterious physical and psychological consequences. Individuals with low pain related fear and avoidance are hypothesized to use a confrontation response to low back pain and gradually return to their normal social and physical functioning. Support for the validity of the FAMEPP is found in longitudinal studies that have demonstrated that pain related fear and avoidance significantly predicts future disability after a low back injury. Treatment based on the FAMEPP involves facilitating confrontation in individuals that normally would not use a confrontation response (i.e. those with high pain related fear and avoidance). Two specific behavioral interventions have been used to facilitate confrontation for patients with low back pain. Graded exposure facilitates confrontation by systematically exposing the individual to situations that they are fearful of and gradually increasing their exposure to such situations. Graded exercise facilitates confrontation by systematically increasing the patients' tolerance to activity (graded exercise). Investigations in the literature support the use of these behavioral interventions, but their effectiveness has not been investigated in patients before they have chronic low back pain. Behavioral interventions that effectively reduce future disability before the onset of chronic symptoms could potentially reduce societal and economic costs associated with low back pain. The purpose of this small grant (RO3) research proposal is to determine the efficacy of a graded exposure rehabilitation intervention for reducing future disability from sub-acute low back pain for patients with elevated fear-avoidance beliefs.