Pfeifer Ann-Christin, Meredith Pamela, Schröder-Pfeifer Paul, Gomez Penedo Juan Martin, Ehrenthal Johannes C, Schroeter Corinna, Neubauer Eva, Schiltenwolf Marcus
Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 20, 69115 Heidelberg, Germany.
J Clin Med. 2019 Mar 14;8(3):364. doi: 10.3390/jcm8030364.
Attachment theory provides a useful framework for understanding individual differences in pain patients, especially with insecure attachment shown to be more prevalent in chronic pain patients compared to the general population. Nevertheless, there is little evidence of attachment-informed treatment approaches for this population. The present study compares outcomes from two different attachment-informed treatment modalities for clinicians, with outcomes from treatment as usual (TAU). In both intervention groups (IG1 and IG2), clinicians received bi-monthly training sessions on attachment. Additionally, clinicians in IG1 had access to the attachment diagnostics of their patients. All treatments lasted for four weeks and included a 6-month follow up. A total of 374 chronic pain patients were recruited to participate in this study (TAU = 159/IG1 = 163/IG2 = 52). Analyses were carried out using multilevel modeling with pain intensity as the outcome variable. Additionally, working alliance was tested as a mediator of treatment efficacy. The study was registered under the trial number DRKS00008715 on the German Clinical Trials Register (DRKS). Findings show that while IG2 was efficient in enhancing treatment outcomes, IG1 did not outperform TAU. In IG2, working alliance was a mediator of outcome. Results of the present study indicate that attachment-informed treatment of chronic pain can enhance existing interdisciplinary pain therapies; however, caveats are discussed.
依恋理论为理解疼痛患者的个体差异提供了一个有用的框架，尤其是不安全依恋在慢性疼痛患者中比在普通人群中更为普遍。然而，几乎没有证据表明针对这一人群有基于依恋的治疗方法。本研究比较了两种不同的基于依恋的治疗方式对临床医生的治疗效果，以及常规治疗（TAU）的效果。在两个干预组（IG1和IG2）中，临床医生每两个月接受一次关于依恋的培训课程。此外，IG1组的临床医生可以获取其患者的依恋诊断结果。所有治疗持续四周，并包括为期6个月的随访。共有374名慢性疼痛患者被招募参与本研究（TAU组 = 159人/IG1组 = 163人/IG2组 = 52人）。分析采用多水平模型，以疼痛强度作为结果变量。此外，工作联盟被作为治疗效果的中介变量进行检验。该研究已在德国临床试验注册中心（DRKS）以试验编号DRKS00008715注册。研究结果表明，虽然IG2组在提高治疗效果方面有效，但IG1组并未优于TAU组。在IG2组中，工作联盟是治疗效果的中介变量。本研究结果表明，基于依恋的慢性疼痛治疗可以增强现有的跨学科疼痛治疗；然而，也讨论了一些注意事项。
