Comparative Mechanisms (Mediators, Moderators) of Psychosocial Chronic Pain Treatments

慢性肌肉骨骼疼痛（CP）是一个主要的公共卫生问题。一些社会心理治疗 在近几十年来出现了帮助解决这个问题。这些干预措施已被证明是 与大部分惰性对照条件相比有效;然而，最近的荟萃分析表明， 这些治疗中的大多数的特征在于对主要结果的适度影响。这是一个关键 这些其他有前途的方法的缺点。而不是仅仅通过 开发新的，希望更强大的干预措施，我们也可以看看我们已经证明， 治疗的方法，以提高治疗效果的幅度。一个策略是增加我们的 了解治疗介质。需要对介质进行研究，直接比较不同的 治疗，以确定哪些介质是治疗特异性的，哪些是共享的， 治疗，并对临床结果贡献最大。这种研究的结果可以用来 为适应现有的治疗方法提供信息，以提高其效益。第二个战略是增加 现有治疗的有益效果是识别患者特征， 应答研究需要以理论模型为指导，并在多个领域测试主持人。 治疗。确定更有可能对一种或另一种治疗产生反应的患者亚组可以推进 通过告知先验的患者-治疗匹配，可以优化治疗效果，从而实现精准医疗。我们将 比较认知行为疗法（CBT），接受和 承诺疗法（ACT）和情绪意识和表达疗法（EAET）。检查 这些治疗的介质和调节剂具有促进治疗开发的巨大潜力， 提高治疗效果。患有慢性脊柱（轴性）疼痛的成人（N=460）将被随机分配到CBT组， ACT、EAET和常规治疗（TAU）。目标1是确定特定的和共享的调解人， 治疗。目标2是确定不同治疗的调节因子。这个项目可以增加我们的影响， 通过确定最有效的治疗机制-特异性和 分享--并揭示谁的调解结果路径最强。经由增加 了解介质和调节剂，可以开发更有效的疼痛治疗方法， 测试和实施。

Chronic musculoskeletal pain (CP) is a major public health concern. A number of psychosocial treatments have emerged in recent decades to help address this problem. These interventions have been shown to be efficacious when compared to largely inert control conditions; however, recent meta-analyses indicate that most of these treatments are characterized by modest effects on primary outcomes. This is a critical shortcoming of these otherwise promising approaches. Rather than attempting to boost efficacy only by developing new and hopefully more powerful interventions, we can also look within our already proven treatments for ways to enhance the magnitude of treatment effects. One strategy is to increase our understanding of treatment mediators. Studies of mediators are needed that directly compare different treatments with each other to determine which mediators are treatment-specific, which are shared across treatments, and which contribute the most to clinical outcomes. The findings from such research could be used to inform adaptations to existing treatment that enhance their benefits. A second strategy for increasing the beneficial effects of existing treatments is to identify the patient characteristics that moderate treatment responses. Research is needed that is guided by theoretical models and that tests moderators across multiple treatments. Identifying subgroups of patients more likely to respond to one or another treatment can advance precision medicine by informing a priori patient-treatment matches that can optimize treatment effects. We will compare the mechanisms and moderators of Cognitive-Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Emotional Awareness and Expression Therapy (EAET). Examining the mediators and moderators of these treatments holds great potential for advancing treatment development and enhancing treatment efficacy. Adults with chronic spinal (axial) pain (N=460) will be randomly assigned to CBT, ACT, EAET and to treatment-as-usual (TAU). Aim 1 is to identify specific and shared mediators across treatments. Aim 2 is to identify moderators across treatments. This project can increase the effects of our psychosocial chronic pain treatments by identifying the most powerful treatment mechanisms – specific and shared -- and revealing for whom the mediator  outcome pathways are strongest. Via increased understanding of mediator and moderators, more effective pain treatment approaches can be developed, tested, and implemented.