Behavioral Interventions for Low Back Pain

描述（由申请人提供）。 心理社会因素在腰痛慢性残疾发展中的主导作用在文献中已经得到了很好的证实。因此，研究人员一直提倡对治疗腰痛的生物心理社会模式进行调查。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，提出个体的疼痛相关恐惧和回避是确定慢性残疾是否由腰痛发作引起的最重要因素。在FAMEPP中，假设具有高度疼痛相关恐惧和回避的个体对腰痛使用回避反应，并且具有有害的身体和心理后果。假设与疼痛相关的恐惧和回避程度较低的个体对腰痛使用对抗反应，并逐渐恢复正常的社会和身体功能。支持FAMEPP的有效性是在纵向研究中发现的，这些研究表明，疼痛相关的恐惧和回避显着预测未来的残疾后，腰痛。基于FAMEPP的治疗涉及促进通常不会使用对抗反应的个体（即具有高度疼痛相关恐惧和回避的个体）的对抗。两种特定的行为干预措施已被用于促进下背痛患者的对抗。分级暴露通过系统地将个人暴露于他们害怕的情况并逐渐增加他们对这种情况的暴露来促进对抗。分级运动通过系统地增加患者对活动的耐受性（分级运动）来促进对抗。文献中的调查支持使用这些行为干预，但其有效性尚未在慢性腰痛患者中进行调查。在慢性症状发作之前有效减少未来残疾的行为干预可能会降低与腰痛相关的社会和经济成本。这项小额资助（RO3）研究提案的目的是确定分级暴露康复干预的有效性，以减少恐惧回避信念升高患者亚急性腰痛的未来残疾。

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.