Emotion regulation as a primary mechanism of action in yoga interventions for chronic low back pain: An RCT testing biological and psychological pathways

摘要 瑜伽已被证明在减轻疼痛和改善功能方面具有持续但温和的效果 慢性下腰痛(CLBP)患者参加多项随机对照试验。回顾与实践 指南支持瑜伽作为CLBP的一种循证治疗，至少有适度的好处，而瑜伽是 作为一种综合疗法越来越多地被应用。然而，瑜伽发挥作用的机制 疼痛严重程度的临床改善和干预尚未确定；这种确定可能会导致 优化瑜伽干预以提高其效力。要确定与以下各项相关的基本机制 瑜伽干预(PA 18-323)和基于全面的瑜伽情绪调节理论模型 由PI开发，我们的目标是测试情绪调节作为瑜伽效果的主要机制，并测试 瑜伽对增强适应性情绪调节的影响可能通过生物途径发挥作用 影响与疼痛相关的功能。情绪强烈地影响对疼痛强度的感知，并预测残疾， 特别是在患有CLBP的患者中，促进情绪调节技能的干预措施 被证明可以减轻疼痛。越来越多的证据表明，持续的瑜伽练习可以促进进步 情绪调节，但研究尚未测试瑜伽练习对CLBP的影响是否源于 情绪调节方面的改进。为了研究这个问题，我们将进行一项随机对照试验 204名CLBP患者在干预前、干预6周、干预后以及3个月和6个月的随访中进行评估 要测试瑜伽干预对情绪调节的影响，相对于没有伸展/加强的情况 冥想或呼吸。其次，我们还将评估瑜伽对CLBP(改善疼痛)的效果 严重程度和功能)是由情绪调节的变化调节的。我们还研究了这种联系是否 情绪调节与疼痛严重程度和功能之间的关系是由疼痛敏感化调节或调节的， 已经被理论上和/或被证明可以解释疼痛变化的影响，从而测试情绪 调节是瑜伽治疗慢性阻塞性肺疾病临床效果的关键机制。

Abstract Yoga has been shown to have consistent but modest effects in reducing pain and improving function in populations with chronic low back pain (CLBP) in multiple randomized controlled trials. Reviews and practice guidelines support yoga as an evidence-based treatment for CLBP with at least moderate benefit and yoga is being increasingly applied as an integrative therapy. However, the mechanisms through which yoga exerts clinical improvements on pain severity and interference have not been identified; such identification might lead to optimizing yoga interventions to improve their potency. To identify underlying mechanisms associated with yoga interventions (PA 18-323) and based on a comprehensive theoretical emotion regulation model of yoga developed by the PI, we aim to test emotion regulation as a primary mechanism of yoga's effects, and to test biological pathways through which yoga's effects on increased adaptive emotion regulation may operate to affect pain-related functioning. Emotions strongly influence perceptions of pain intensity and predict disability, particularly among individuals with CLBP, and interventions that promote emotion regulation skills have been shown to reduce pain. Increasing evidence demonstrates that consistent yoga practice can promote improved emotion regulation, but research has not yet tested whether the effects of yoga practice on CLBP are due to improvements in emotion regulation. To examine this issue, we will conduct a randomized controlled trial of 204 people with CLBP assessed pre-intervention, 6 weeks, post-intervention and at 3- and 6-month follow-up to test the impact of a yoga intervention on emotion regulation relative to stretching/strengthening without meditation or breathwork. Secondarily, we will also assess whether yoga's effects on CLBP (improved pain severity and functioning) are mediated by changes in emotion regulation. We also examine whether the link between emotion regulation and pain severity and functioning is moderated or mediated by pain sensitization, effects that have been theorized and/or demonstrated to account for changes in pain, thereby testing emotion regulation as a key mechanism underlying the clinical effects of yoga on CLBP.