基于健康心理学的创新性慢性疼痛管理方案：正念–接受–承诺整合干预

Innovative Chronic Pain Management Program Based on Health Psychology: A Mindfulness-Acceptance-Commitment Integrated Intervention

摘要: 慢性腰痛(CLBP)是一种不仅与外周结构改变相关，还常伴随中枢敏化与疼痛加工脑网络重塑，并在心理与社会层面引发灾难化认知、情绪困扰、恐惧–回避行为及角色功能受损等的连锁反应。为应对上述机制，本文基于健康心理学提出一套“正念–接受与承诺–健康行为改变”整合干预方案：理论上融合正念减压、ACT及行为改变技术，并结合相关研究证据支持其对疼痛体验、情绪症状、功能状态与医疗资源使用的潜在获益。方案在实施上设计为多模块、循序渐进的综合项目，包含团体正念训练与家庭练习、ACT价值澄清与承诺行动计划、分阶段运动处方与行为激活、自我管理教育以及随访与同伴支持系统。该整合模式旨在同时打破“疼痛–灾难化/负性情绪–回避–去条件化/功能下降”的恶性循环，增强自我效能与长期自我管理能力，从而改善CLBP患者的功能水平与生活质量。

Abstract: Chronic low back pain (CLBP) is a condition not only associated with peripheral structural changes, but also often accompanied by central sensitization and the remodeling of pain-processing brain networks. It triggers a cascade of psychological and social consequences, including catastrophic cognition, emotional distress, fear-avoidance behaviors, and impaired role functioning. To address these mechanisms, this study proposes an integrated intervention program based on health psychology: “Mindfulness-Acceptance and Commitment-Health Behavior Change”. Theoretically, it integrates mindfulness-based stress reduction, acceptance and commitment therapy (ACT), and behavior change techniques. Supported by relevant research evidence, the program demonstrates potential benefits in pain experience, emotional symptoms, functional status, and the utilization of medical resources. In practice, the program is designed as a multi-module, step-by-step comprehensive project, including group mindfulness training and home practice, ACT value clarification and commitment action plans, staged exercise prescriptions and behavioral activation, self-management education, and a follow-up and peer support system. This integrated model aims to break the vicious cycle of “pain-catastrophizing/negative emotions-avoidance-deconditioning/functional decline”, enhance self-efficacy and long-term self-management capacity, thereby improving the functional level and quality of life of patients with CLBP.