Vlaeyen Johan W S, Morley Stephen
Department of Medical, Clinical, and Experimental Psychology, Maastricht University, Maastricht, The Netherlands.
Clin J Pain. 2005 Jan-Feb;21(1):1-8. doi: 10.1097/00002508-200501000-00001.
Since the introduction of behavioral medicine in the early 70s, cognitive-behavioral treatment interventions for chronic pain have expanded considerably. It is now well established that these interventions are effective in reducing the enormous suffering that patients with chronic pain have to bear. In addition, these interventions have potential economic benefits in that they appear to be cost-effective as well. Despite these achievements, there is still room for improvement. First, there is a substantial proportion of patients who do not appear to benefit from treatment interventions available. Second, although the effect sizes of most cognitive-behavioral treatments for chronic pain are comparable to those in psychopathology, they are quite modest. Third, there is little evidence for differential outcomes for different treatment methods. Fourth, there still is relatively little known about the specific biobehavioral mechanisms that lead to chronic pain and pain disability. One direction is to better match treatment programs to patients' characteristics. This can be done according to an "Aptitude X Treatment Interaction" framework, or from the perspective of the Moderator-Mediator distinction. In this introduction to the special series on what works for whom in cognitive-behavioral treatments for chronic pain, we review existing knowledge concerning both moderating and mediating variables in cognitive-behavioral treatments for chronic pain. We further argue in favor of theory-driven research as the only way to define specific a priori hypotheses about which patient-treatment interactions to expect. We also argue that replicated single-participant studies, with appropriate statistics, are likely to enhance new developments in this clinical research area.
自20世纪70年代初行为医学问世以来，针对慢性疼痛的认知行为治疗干预措施有了相当大的扩展。现在已经充分证实，这些干预措施在减轻慢性疼痛患者所承受的巨大痛苦方面是有效的。此外，这些干预措施还具有潜在的经济效益，因为它们似乎也具有成本效益。尽管取得了这些成就，但仍有改进的空间。首先，有相当一部分患者似乎并未从现有的治疗干预措施中受益。其次，虽然大多数针对慢性疼痛的认知行为治疗的效应量与心理病理学中的效应量相当，但它们相当有限。第三，几乎没有证据表明不同治疗方法会产生不同的结果。第四，对于导致慢性疼痛和疼痛残疾的具体生物行为机制，人们仍然知之甚少。一个方向是使治疗方案更好地与患者特征相匹配。这可以根据“能力×治疗相互作用”框架来进行，或者从中介调节变量的角度来进行。在这个关于认知行为治疗慢性疼痛中何种方法对何人有效的特别系列介绍中，我们回顾了有关慢性疼痛认知行为治疗中调节变量和中介变量的现有知识。我们进一步主张理论驱动的研究是定义关于预期哪些患者 - 治疗相互作用的特定先验假设的唯一途径。我们还认为，采用适当统计方法的重复单病例研究可能会促进这一临床研究领域的新发展。
