Psychological Treatment of Disability-Related Pain: Efficacy and Mechanisms

描述（由申请人提供）：本研究计划的长期目标是开发和测试残疾相关疼痛的创新治疗方法，并增加我们对这些治疗效果机制的理解，以便（1）最大限度地提高心理疼痛治疗的有效性和（2）更好地将个体患者与特定治疗相匹配。有证据表明，认知疗法和自我催眠训练都可以减少残疾相关疼痛患者的慢性疼痛。然而，缺乏对这些治疗的长期影响以及研究这些治疗机制的研究。此外，认知疗法和催眠可能具有协同效应;然而，研究人员尚未测试结合两者的新疗法是否比单独的认知疗法或催眠疗法更能提高疗效。拟议的研究将检查催眠认知疗法的疗效，相对于教育控制条件和标准认知疗法和催眠，以确定这种新的干预措施是否有益于患有多发性硬化症和脊髓损伤的慢性疼痛患者。它还将测试 与三种可能的积极治疗机制有关的假设。具体而言，本研究将确定治疗的有益效果是否因为它们（1）改变PAI相关认知内容，（2）改变疼痛相关认知应对，以及（3）特别是对于催眠和催眠认知治疗，增强与疼痛缓解相关的大脑状态而发生。分析将检验以下假设：（1）催眠认知疗法、认知疗法和自我催眠训练将导致治疗前至治疗后每日疼痛强度比教育对照干预更大的降低，（2）催眠认知疗法将导致疼痛强度比认知疗法或催眠更大的降低，以及（3）三种积极治疗的有益效果。相对于对照条件，将通过疼痛相关认知内容、认知应对和脑状态（如通过脑电图测量的）的变化来介导。这项研究的结果将增加我们对三种心理治疗慢性残疾相关疼痛的疗效和效果的理解。研究结果还将有助于我们理解心理疼痛治疗如何以及为什么起作用，为提高其疗效和匹配患者治疗提供经验基础。所有这些结果将有助于我们的长期目标，即为身体残疾者提供有效的慢性疼痛治疗。

DESCRIPTION (provided by applicant): The long-term objectives of this research program are to develop and test innovative treatments for disability-related pain and increase our understanding of the mechanisms of the effects of these treatments in order to (1) maximize the effectiveness of psychological pain treatments and (2) better match individual patients to specific treatments. Evidence indicates that both cognitive therapy and self-hypnosis training can reduce chronic pain in individuals with disability-related pain. However, research on the long-term effects of these treatments as well as research studying the mechanism(s) of these treatments is lacking. Moreover, cognitive therapy and hypnosis may have synergistic effects; yet researchers have not yet tested whether a novel treatment that combines both enhances outcomes over either cognitive therapy or hypnosis alone. The proposed study will examine the efficacy of hypnotic cognitive therapy, relative to both an education control condition and to standard cognitive therapy and hypnosis, in order to determine if this new intervention benefits individuals with multiple sclerosis and spinal cord injury who have chronic pain. It will also test hypotheses related to three possible mechanisms of the active treatments. Specifically, the study will determine if their beneficial effects of the treatments occur because they (1) alter pai-related cognitive content, (2) alter pain- related cognitive coping, and (3) especially for hypnosi and hypnotic cognitive therapy, enhance brain states that are associated with pain relief. Analyses will test the hypothesis that (1) hypnotic cognitive therapy, cognitive therapy, and self-hypnosis training will result in larger pre- to post-treatment decreases in daily pain intensity thn an education control intervention, (2) hypnotic cognitive therapy will result in larger decreases i pain intensity than cognitive therapy or hypnosis, and (3) the beneficial effects of the three active treatments, relative to the control condition, will be mediated by changes in pain-related cognitive content, cognitive coping, and brain state (as measured by electroencephalogram). The findings from this study will increase our understanding of the efficacy and effects of three psychological treatments for chronic disability-related pain. The study findings will also contribute to our understanding of how and why psychological pain treatments work, providing an empirical foundation for enhancing their efficacy and matching patients to treatment. All of these outcomes will contribute to our long-term goal of increasing the availability of effective chronic pain treatments for individuals with physical disabilities.