Highlights
- •This is the first test of the Limit, Activate and Enhance model of moderation.
- •Differing patient characteristics moderated outcomes across treatments.
- •Theory-driven moderation research could inform optimal patient-treatment matching.
Abstract
This study examined psychosocial pain treatment moderation in a secondary analysis
of a trial that compared cognitive therapy (CT), mindfulness-meditation (MM), and
mindfulness-based cognitive therapy (MBCT) for chronic low back pain (CLBP). The Limit,
Activate, and Enhance (LA&E) model of moderation provided a framework for testing
a priori hypotheses. Adult participants (N = 69) with CLBP completed a pretreatment
assessment of hypothesized moderators: pain catastrophizing, brain state as assessed
by electroencephalogram, mindful observing, and nonreactivity. Outcomes were pain
interference, characteristic pain intensity, physical function, and depression, assessed
at pre- and post-treatment. Moderation analyses found significant interaction effects,
specifically: 1) higher and lower baseline pain catastrophizing was associated with
greater improvement in pain intensity in MM and MBCT, respectively; 2) higher baseline
theta power was associated with greater improvement in depression in MBCT and interfered
with response to CT; 3) lower baseline nonreactivity was associated with greater improvement
in physical function in MM while higher nonreactivity was associated with greater
improvement in MBCT. The findings support the possibility that different patients
are more or less likely to benefit from various treatments. Theory-driven moderation
research has the capacity to inform the development of patient-treatment matching
algorithms to optimize outcome.
Perspective
This study presents preliminary findings from theory-driven tests of the moderators
of mindfulness meditation, cognitive therapy, and mindfulness-based cognitive therapy
for chronic low back pain. The results of such analyses may inform the understanding
of for whom various evidence-based psychosocial pain treatments may engender the most
meaningful benefits.
Key Words
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Article info
Publication history
Published online: June 25, 2019
Accepted:
June 19,
2019
Received in revised form:
June 11,
2019
Received:
November 26,
2018
Footnotes
This study was supported by an Early Career Fellowship Grant from the National Health and Medical Research Council APP1092089, as well as start-up funds from the University of Queensland, awarded to the first author.
The authors have no conflicts of interest to report.
Identification
Copyright
© 2019 by United States Association for the Study of Pain, Inc.
