INPUT Pain Management, Guys and St.Thomas NHS Foundation Trust Hospitals, London, UK.
Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Eur J Pain. 2019 Feb;23(2):354-366. doi: 10.1002/ejp.1310. Epub 2018 Sep 24.
Psychological treatments are known to be effective for chronic pain, but little is understood about which patients are most likely to benefit from which ones.
The study reported here included 609 people who attended a residential, interdisciplinary, pain management programme based on Acceptance and Commitment Therapy between January 2012 and August 2014. A flexible and theoretically guided approach to model building based on fractional polynomials was used to identify potential predictors of outcome in domains of emotional, physical and social functioning and pain intensity. Variables considered for inclusion were baseline demographic variables along with measures reflecting processes of psychological flexibility, including acceptance, cognitive defusion and committed action.
Employment status, level of distress, decentring (a process like cognitive defusion) and acceptance significantly contributed to the model above and beyond the effects of other baseline variables. The unique effects of these were small but may be clinically relevant.
Future research should continue to investigate moderators of treatment outcome and to explicitly link these to treatment mechanisms. Taking a flexible, theoretically driven approach to modelling continuous outcomes may be valuable in furthering our understanding of which patients might respond best to which treatments.
Further research is needed to better understand who benefits most from psychological treatments for chronic pain. This study suggests that a flexible, multivariate and theoretical approach to identifying predictors of outcome may be valuable in furthering research in this area.
心理治疗对慢性疼痛是有效的，但对于哪些患者最有可能从哪种治疗中获益，人们知之甚少。
本研究纳入了 2012 年 1 月至 2014 年 8 月期间参加基于接纳与承诺疗法的住院式跨学科疼痛管理项目的 609 名患者。采用基于分数多项式的灵活且具有理论指导的建模方法，以确定在情绪、身体和社会功能以及疼痛强度领域中，潜在的结局预测因子。考虑纳入的变量包括基线人口统计学变量，以及反映心理灵活性过程的测量指标，包括接纳、认知解离和承诺行动。
就业状况、苦恼程度、去中心化（类似于认知解离的过程）和接纳对模型的贡献超过了其他基线变量的影响。这些变量的独特影响虽小，但可能具有临床意义。
未来的研究应继续调查治疗结果的调节因素，并将这些因素与治疗机制明确联系起来。采取灵活的、基于理论的方法来对连续结果进行建模可能有助于进一步了解哪些患者可能对哪些治疗反应最好。
需要进一步的研究来更好地了解慢性疼痛的心理治疗对哪些患者最有效。本研究表明，采用灵活的、多变量和理论驱动的方法来确定结局预测因子可能对该领域的研究具有价值。
