Thieme K, Turk D C
Department of Medical Psychology, Philipps-University of Marburg, Karl-von-Frisch-Str. 5, 35032 Marburg, Germany.
Reumatismo. 2012 Sep 28;64(4):275-85. doi: 10.4081/reumatismo.2012.275.
The current article reviews the cognitive-behavioral (CB) and operant-behavioral perspectives on chronic pain and suggests an answer to the question why changes in behaviors, attitudes, and emotions are associated with decreases in pain severity and impact discussing potential psychobiological mechanisms that may underlie cognitive and behavioral techniques. The impact of learning such as classical and operant conditioning in behaviors and physical responses including baroreflex sensitivity (BRS), as well as the influence of cognitions on pain perception and impact will be presented to explain general efficacy of cognitive-behavior therapy (CBT) and operant-behavioral therapy (OBT) in the treatment of people with fibromyalgia (FM) describing some of the limitations of published outcome studies. We discuss advances in moderation and mediation of treatment outcomes. Lastly, we will discuss the need for research that takes into account evidence-based medicine, methods that address treatment responders and non-responders, individual trajectories, how we might advance and refine CBT and OBT, and strategies related to relapse prevention, maintenance, and adherence-enhancement taking advantage of evolving, technological methods of service delivery. We provide recommendations of how to move forward in approaching studies of CBT and OBT efficacy as a function of better understanding of patient characteristics and contextual factors. We advocate for the potential of the CB perspective and principle of learning for all health care providers regardless of discipline or training and will give examples for making more effective the patient-rheumatologist-relationship by using the principles discussed.
本文回顾了关于慢性疼痛的认知行为和操作性行为观点，并就行为、态度和情绪的改变为何与疼痛严重程度和影响的降低相关这一问题给出答案，同时讨论了认知和行为技术背后可能存在的心理生物学机制。文中将阐述经典条件作用和操作性条件作用等学习方式在行为及包括压力反射敏感性（BRS）在内的生理反应中的影响，以及认知对疼痛感知和影响的作用，以解释认知行为疗法（CBT）和操作性行为疗法（OBT）在治疗纤维肌痛（FM）患者中的总体疗效，并描述已发表的疗效研究的一些局限性。我们将讨论治疗结果调节和中介方面的进展。最后，我们将探讨开展研究的必要性，该研究需考虑循证医学、针对治疗反应者和无反应者的方法、个体轨迹、如何推进和完善CBT和OBT，以及利用不断发展的技术服务提供方式进行预防复发、维持治疗和增强依从性的策略。我们就如何根据对患者特征和背景因素的更好理解推进CBT和OBT疗效研究提供建议。我们倡导认知行为观点和学习原则对所有医疗保健提供者的潜在价值，无论其学科或培训背景如何，并将举例说明如何运用所讨论的原则来改善患者与风湿病学家之间的关系。
