INPUT Pain Management, Guys and St Thomas NHS Foundation Trust Hospitals, London, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
J Pain. 2017 Oct;18(10):1153-1164. doi: 10.1016/j.jpain.2017.04.003. Epub 2017 Apr 26.
There is increasing evidence that contextual forms of cognitive-behavioral therapy (CBT) are effective in the management of chronic pain, yet little is understood about the factors that moderate or predict outcomes in these treatments. This systematic review aimed to identify pretreatment participant characteristics associated with positive treatment responses in contextual CBT for chronic pain. Medline, EMBASE, PsychINFO, and CENTRAL were searched to identify eligible studies. Studies were included if the participants were adults with chronic pain, designs were longitudinal, treatments focused on psychological flexibility or mindfulness, and reported results allowed for examination of moderators or predictors of standard treatment outcomes. Of 991 records initially identified, 20 were eligible for inclusion in the review. Some evidence suggested that baseline emotional functioning predicts treatment response, but the direction of this association varied between studies. Substantive findings were inconsistent and inconclusive, however, methodological limitations were consistent. These included treatment heterogeneity, and a lack of theoretical, a priori guidance in examining potential predictors. Future research should adopt a theoretically based approach to examining moderators in relation to specific treatment methods and therapeutic processes. Considering moderation without first considering mediation is probably a limited strategy.
In this systematic review we examined evidence for potential predictors or moderators of outcomes in contextual CBT for chronic pain. Substantive findings were inconclusive but important methodological limitations and a lack of theoretical guidance were found. Future research should explicitly plan relevant methods and follow clear theoretical models.
越来越多的证据表明，情境形式的认知行为疗法（CBT）在慢性疼痛的管理中是有效的，但对于这些治疗中调节或预测结果的因素知之甚少。本系统评价旨在确定与慢性疼痛的情境 CBT 中积极治疗反应相关的治疗前参与者特征。检索了 Medline、EMBASE、PsychINFO 和 CENTRAL 以确定符合条件的研究。如果参与者是患有慢性疼痛的成年人，设计是纵向的，治疗重点是心理灵活性或正念，并且报告的结果允许检查标准治疗结果的调节因素或预测因素，则研究符合纳入标准。最初确定的 991 条记录中，有 20 条符合纳入审查的条件。一些证据表明，基线情绪功能预测治疗反应，但这种关联在研究之间的方向不同。实质性发现不一致且没有结论，但方法学限制是一致的。这些限制包括治疗异质性，以及在检查潜在预测因素时缺乏理论上的、事先的指导。未来的研究应采用基于理论的方法来检查与特定治疗方法和治疗过程相关的调节因素。在不首先考虑中介的情况下考虑调节可能是一种有限的策略。
在本系统评价中，我们检查了慢性疼痛的情境 CBT 中结局的潜在预测因素或调节因素的证据。实质性发现没有结论，但发现了重要的方法学限制和缺乏理论指导。未来的研究应明确计划相关方法并遵循明确的理论模型。
