Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial

被引：51

作者：

Yarns, Brandon C. ^{[1
,2
]}

Lumley, Mark A. ^{[3
]}

Cassidy, Justina T. ^{[1
]}

Steers, W. Neil ^{[4
,5
]}

Osato, Sheryl ^{[1
,2
]}

Schubiner, Howard ^{[6
,7
]}

Sultzer, David L. ^{[8
]}

机构：

[1] VA Greater Los Angeles Healthcare Syst, Dept Mental Hlth, 11301 Wilshire Blvd,Bldg 401,116AE, Los Angeles, CA 90073 USA

[2] Univ Calif Los Angeles UCLA, David Geffen Sch Med, Dept Psychiat & Biobehav Sci, Los Angeles, CA USA

[3] Wayne State Univ, Dept Psychol, 71 W Warren Ave, Detroit, MI 48202 USA

[4] VA Greater Los Angeles Healthcare Syst, VA HSR&D Ctr Study Healthcare Innovat Implementat, Los Angeles, CA 90073 USA

[5] UCLA, David Geffen Sch Med, Div Gen Internal Med & Hlth Serv Res, Dept Med, Los Angeles, CA 90095 USA

[6] Ascens Providence Hosp, Dept Internal Med, Southfield, MI USA

[7] Michigan State Univ, Dept Med, Coll Human Med, E Lansing, MI 48824 USA

[8] Univ Calif Irvine, Dept Psychiat & Human Behav, Irvine Sch Med, Irvine, CA 92717 USA

来源：

PAIN MEDICINE | 2020年 / 21卷 / 11期

关键词：

Chronic Pain; Cognitive Behavioral Therapy; Emotional Awareness; Emotional Expression; Older Adults; Randomized Clinical Trial; LOW-BACK-PAIN; MEDICALLY UNEXPLAINED PAIN; TERM DYNAMIC PSYCHOTHERAPY; ANGER EXPRESSION; CLINICAL-TRIAL; PATIENT PAIN; DEPRESSION; HEALTH; AGE; FIBROMYALGIA;

D O I：

10.1093/pm/pnaa145

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Objective. Emotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain. Design. Randomized comparison trial. Setting. Outpatient clinics at the West Los Angeles VA Medical Center. Subjects. Fifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain. Methods. Patients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up. Results. EAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large partial eta(2) = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance. Conclusions. This trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.

引用

页码：2811 / 2822

页数：12

共 66 条

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