Luciano Juan V, Guallar José A, Aguado Jaume, López-Del-Hoyo Yolanda, Olivan Bárbara, Magallón Rosa, Alda Marta, Serrano-Blanco Antoni, Gili Margalida, Garcia-Campayo Javier
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi del Llobregat, Spain Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain Regional Office of Education, Culture, & Sports, Government of Aragon, Zaragoza, Spain Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain Primary Healthcare Center Arrabal, Zaragoza, Spain Department of Psychiatry, Miguel Servet Hospital, Aragon Institute of Health Sciences (I+CS), Zaragoza, Spain Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma, Spain.
Pain. 2014 Apr;155(4):693-702. doi: 10.1016/j.pain.2013.12.029. Epub 2013 Dec 28.
In the last decade, there has been burgeoning interest in the effectiveness of third-generation psychological therapies for managing fibromyalgia (FM) symptoms. The present study examined the effectiveness of acceptance and commitment therapy (ACT) on functional status as well as the role of pain acceptance as a mediator of treatment outcomes in FM patients. A total of 156 patients with FM were enrolled at primary health care centers in Zaragoza, Spain. The patients were randomly assigned to a group-based form of ACT (GACT), recommended pharmacological treatment (RPT; pregabalin + duloxetine), or wait list (WL). The primary end point was functional status (measured with the Fibromyalgia Impact Questionnaire, FIQ). Secondary end points included pain catastrophizing, pain acceptance, pain, anxiety, depression, and health-related quality of life. The differences between groups were calculated by linear mixed-effects (intention-to-treat approach) and mediational models through path analyses. Overall, GACT was statistically superior to both RPT and WL immediately after treatment, and improvements were maintained at 6months with medium effect sizes in most cases. Immediately after treatment, the number needed to treat for 20% improvement compared to RPT was 2 (95% confidence interval 1.2-2.0), for 50% improvement 46, and for achieving a status of no worse than mild impaired function (FIQ total score <39) also 46. Unexpectedly, 4 of the 5 tested path analyses did not show a mediation effect. Changes in pain acceptance only mediated the relationship between study condition and health-related quality of life. These findings are discussed in relation to previous psychological research on FM treatment.
在过去十年中，人们对第三代心理疗法治疗纤维肌痛（FM）症状的有效性兴趣激增。本研究考察了接受与承诺疗法（ACT）对功能状态的有效性，以及疼痛接纳作为FM患者治疗结果中介因素的作用。共有156名FM患者在西班牙萨拉戈萨的初级医疗保健中心登记入组。患者被随机分配至基于团体形式的ACT（GACT）组、推荐的药物治疗组（RPT；普瑞巴林+度洛西汀）或等待列表组（WL）。主要终点是功能状态（采用纤维肌痛影响问卷，FIQ进行测量）。次要终点包括疼痛灾难化、疼痛接纳、疼痛、焦虑、抑郁以及健康相关生活质量。通过线性混合效应（意向性分析方法）和路径分析的中介模型计算组间差异。总体而言，治疗后即刻GACT在统计学上显著优于RPT和WL，并且在6个月时多数情况下改善得以维持，效应量中等。治疗后即刻，与RPT相比，实现20%改善所需治疗人数为2（95%置信区间1.2 - 2.0），实现50%改善所需治疗人数为46，实现功能损害不超过轻度（FIQ总分<39）状态所需治疗人数也为46。出乎意料的是，5项测试的路径分析中有4项未显示出中介效应。疼痛接纳的变化仅介导了研究条件与健康相关生活质量之间的关系。结合先前关于FM治疗的心理学研究对这些发现进行了讨论。
