Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States.
School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.
Pain. 2021 Jul 1;162(7):2036-2050. doi: 10.1097/j.pain.0000000000002201.
The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.
本研究使用临床试验数据，确定与 4 种心理慢性疼痛治疗的有益效果相关和/或中介的变量：一种是教导患者自我催眠以减轻疼痛强度（HYP），一种是教导自我催眠以改变对疼痛的看法（催眠认知疗法[HYP-CT]），一种是教授认知重构技能以改变对疼痛的看法（认知疗法[CT]），一种是提供有关疼痛的教育（ED；作为一种积极的对照条件）。在检查的 17 个可能的机制变量中，未对多个比较进行α校正，观察到 3 个组间存在显著差异。其中 2 个（对疼痛控制的信念变化和技能实践天数）支持 HYP、CT 或 HYP-CT 的有益效果的中介，相对于 ED。6 个机制变量在整个样本中表现出治疗前到治疗后的显著变化，而没有显示出组间差异。所有 6 个变量的治疗前到治疗后的变化均与疼痛干扰、疼痛强度或两者的改善相关。此外，治疗后治疗联盟的参与者评分与整个样本的疼痛强度和疼痛干扰的改善显著相关。因此，在所检查的 17 个可能的中介中，很少有作为特定治疗效果的中介；更多的变量预测了总体治疗结果。这些变量在多大程度上是治疗中介（即，是治疗相关改善的原因，而不仅仅是与治疗相关的改善），这将需要进一步的研究。
