Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada.
Behavioural Science-BSB, York University, Toronto, ON, Canada.
Pain. 2020 Mar;161(3):584-594. doi: 10.1097/j.pain.0000000000001746.
Persons with chronic musculoskeletal pain may be hypervigilant for pain-related cues which, paradoxically, may be maintaining their pain. Several randomized controlled trials have assessed whether a modified dot-probe protocol (ie, attention bias modification [ABM]) reduces chronic pain- and pain-related symptoms in persons with several diagnoses, including fibromyalgia. Scalability and economic efficiency potentiates the appeal of ABM protocols; however, research results have been mixed, with only some studies evidencing significant symptom gains from ABM and some evidencing gains for the control group. The current randomized controlled trial sought to replicate and extend previous ABM research using idiosyncratic word stimuli and a 1-month follow-up. Participants included treatment-seeking adult women (n = 117) with fibromyalgia who were randomly assigned to a standard (ie, control) or active (ie, ABM) condition. The protocol was delivered online and involved twice-weekly 15-minute sessions, for 4 weeks, with questionnaires completed at baseline, posttreatment, and 1-month follow-up. Symptom reports were analysed with mixed hierarchical modelling. There was no evidence of differences between the control and ABM groups. Both groups had small significant (Ps < 0.05) improvements in pain experiences at posttreatment, but not at follow-up (Ps > 0.05). There were no significant changes for either group on measures of anxiety sensitivity, illness/injury sensitivity, pain-related fear, pain-related anxiety, or attentional biases (Ps > 0.05). The current findings add to the emerging and mixed literature regarding ABM for pain by demonstrating that ABM produces no substantive improvements in pain or pain-related constructs in a large sample of patients with fibromyalgia.
患有慢性肌肉骨骼疼痛的人可能对与疼痛相关的线索高度敏感，而这种敏感性可能会持续加重他们的疼痛。有几项随机对照试验评估了改良点探测方案（即注意偏向矫正[ABM]）是否可以减轻包括纤维肌痛在内的多种诊断患者的慢性疼痛和与疼痛相关的症状。可扩展性和经济效益增加了 ABM 方案的吸引力；然而，研究结果喜忧参半，只有一些研究表明 ABM 显著改善了症状，而另一些研究则表明对照组的症状有所改善。本随机对照试验旨在使用独特的单词刺激和 1 个月的随访来复制和扩展之前的 ABM 研究。参与者包括接受治疗的成年女性（n = 117），患有纤维肌痛，她们被随机分配到标准（即对照组）或主动（即 ABM）条件。方案通过在线交付，包括每周两次、每次 15 分钟的 4 周疗程，在基线、治疗后和 1 个月随访时完成问卷。症状报告采用混合分层模型进行分析。对照组和 ABM 组之间没有证据表明存在差异。两组在治疗后都有较小的（P < 0.05）显著改善（P < 0.05），但在随访时没有（P > 0.05）。两组在焦虑敏感性、疾病/伤害敏感性、疼痛相关恐惧、疼痛相关焦虑或注意力偏向（P > 0.05）方面都没有显著变化。当前的研究结果增加了关于 ABM 治疗疼痛的新兴和混杂文献，证明 ABM 在大型纤维肌痛患者样本中没有显著改善疼痛或与疼痛相关的结构。
