Vowles Kevin E, Witkiewitz Katie, Levell Jayne, Sowden Gail, Ashworth Julie
Department of Psychology.
IMPACT Pain Service, National Health Service.
J Consult Clin Psychol. 2017 Feb;85(2):87-98. doi: 10.1037/ccp0000159. Epub 2016 Dec 19.
A key issue in chronic pain treatment concerns the changes necessary for improved physical and emotional functioning. Traditionally, reducing pain intensity and pain-related distress have been viewed as a prerequisite for these improvements. Alternatively, acceptance and commitment therapy, a behavior change approach, theorizes that pain and distress reduction are not necessary for improvement, rather responses must change, such that functioning improves in clearly specified areas (e.g., engagement in valued activities, decreased disability in social activity) even when pain and distress persist.
This study sought to directly examine aspects of change in pain and distress over the course of an interdisciplinary program of acceptance and commitment therapy in relation to functioning at treatment's conclusion and a 3-month follow-up in 174 treated patients. Latent change trajectories of pain intensity and pain-related distress were assessed weekly over 4 weeks of treatment and analyzed via latent growth curve and growth mixture modeling.
A single latent trajectory with a decreasing quadratic slope was indicated for pain, while 2 separate trajectories were identified for pain-related distress 1 of linear decrease and the other an early increase followed by a decrease to initial level. Overall, and with only 3 exceptions across multiple tests, results indicated that trajectories of pain and distress during treatment were not significantly associated with improvements in functioning at treatment's conclusion and follow-up.
This pattern of findings suggests that significant improvements in functioning may not require decreases in pain intensity and pain-related distress during treatment for chronic pain. (PsycINFO Database Record
慢性疼痛治疗中的一个关键问题涉及为改善身体和情绪功能所必需的改变。传统上，减轻疼痛强度和与疼痛相关的痛苦被视为这些改善的先决条件。与之不同的是，接纳与承诺疗法作为一种行为改变方法，其理论认为减轻疼痛和痛苦并非改善的必要条件，相反，反应必须改变，以便即使疼痛和痛苦持续存在，在明确规定的领域（如参与有价值的活动、减少社交活动中的残疾）功能仍能得到改善。
本研究旨在直接考察174名接受治疗的患者在接受跨学科接纳与承诺治疗项目过程中疼痛和痛苦的变化情况，以及治疗结束时和3个月随访时的功能状况。在4周的治疗过程中，每周评估疼痛强度和与疼痛相关的痛苦的潜在变化轨迹，并通过潜在增长曲线和增长混合模型进行分析。
疼痛呈现出一条二次斜率下降的单一潜在轨迹，而与疼痛相关的痛苦则识别出两条不同的轨迹，一条呈线性下降，另一条是早期上升后下降至初始水平。总体而言，在多项测试中仅有3个例外，结果表明治疗期间疼痛和痛苦的轨迹与治疗结束时及随访时功能的改善没有显著关联。
这一研究结果模式表明，对于慢性疼痛治疗，功能的显著改善可能并不需要在治疗期间降低疼痛强度和与疼痛相关的痛苦。（《心理学文摘数据库记录》 ）
