Holroyd Kenneth A, Labus Jenifer S, Carlson Bruce
Psychology Department, Ohio University, 200 Porter Hall, Athens, OH 45701-2979, USA Center for Neurobiology of Stress, Connectivity and Computational Statistics Division, University of California at Los Angeles, USA.
Pain. 2009 Jun;143(3):213-222. doi: 10.1016/j.pain.2009.02.019. Epub 2009 Apr 1.
We evaluated two putative moderators of treatment outcome as well as the role of Headache Management Self-Efficacy (HMSE) in mediating treatment outcomes in the drug and non-drug treatment of chronic tension-type headache (CTTH). Subjects were 169 participants (M=38 yrs.; 77% female; M headache days/mo.=22) who received one of four treatments in the treatment of CTTH trial (JAMA, 2001; 285: 2208-15): tricyclic antidepressant medication, placebo, (cognitive-behavioral) stress-management therapy plus placebo, and stress-management therapy plus antidepressant medication. Severity of CTTH disorder and the presence of a psychiatric (mood or anxiety) disorder were found to moderate outcomes obtained with the three active treatments and with placebo, as well as to moderate the role of HMSE in mediating improvements. Both moderator effects appeared to reflect the differing influence of the moderator variable on each of the three active treatments, as well as the fact that the moderator variables exerted the opposite effect on placebo than on the active treatments. HMSE mediated treatment outcomes in the two stress-management conditions, but the pattern of HMSE mediation was complex, varying with the treatment condition, the outcome measure, and the moderator variable. Irrespective of the severity of the CTTH disorder HMSE fully mediated observed improvements in headache activity in the two stress-management conditions. However, for patients with a mood or anxiety disorder HMSE only partially mediated improvements in headache disability, suggesting an additional therapeutic mechanism is required to explain observed improvements in headache disability in the two stress-management conditions.
我们评估了两个假定的治疗结果调节因素，以及头痛管理自我效能感（HMSE）在慢性紧张型头痛（CTTH）药物和非药物治疗中对治疗结果的中介作用。研究对象为169名参与者（平均年龄=38岁；77%为女性；每月平均头痛天数=22天），他们在CTTH治疗试验（《美国医学会杂志》，2001年；285：2208 - 15）中接受了四种治疗之一：三环类抗抑郁药物、安慰剂、（认知行为）压力管理疗法加安慰剂，以及压力管理疗法加抗抑郁药物。研究发现，CTTH障碍的严重程度和精神（情绪或焦虑）障碍的存在会调节三种有效治疗和安慰剂所获得的结果，也会调节HMSE在介导改善方面的作用。这两种调节作用似乎都反映了调节变量对三种有效治疗中每种治疗的不同影响，以及调节变量对安慰剂的影响与对有效治疗的影响相反这一事实。HMSE在两种压力管理条件下介导了治疗结果，但HMSE的中介模式很复杂，随治疗条件、结果测量指标和调节变量而变化。无论CTTH障碍的严重程度如何，HMSE在两种压力管理条件下都完全介导了观察到的头痛活动改善。然而，对于患有情绪或焦虑障碍的患者，HMSE仅部分介导了头痛残疾的改善，这表明需要一种额外的治疗机制来解释在两种压力管理条件下观察到的头痛残疾改善情况。
