| ObjectiveTo explore the cognitive characteristics and coping strategies for pain of chronic tension-type headache patients,and to evaluate the effects of cognitive behavioral therapy on cognitions,emotions,and pain perception.Choose 64 chronic tension-type headache patients,and separate them to 3 groups randomly.The 3 groups will be given 3 different interventions,which are cognitive behavior therapy(CBT),fluoxetine therapy and the combination of the two methods before.The CBT is a special CBT which is to correct the unhealthy cognition and coping strategies for pain.Hamilton anxiety rating scale(HAMA),Hamilton rating scale for depression(HAMD),coping strategies questionnaire(CSQ),pain catastrophizing scale(PCS),brief pain inventory(BPI) and automatic thought questionnaires(ATQ) will be finished before and after the intervention in the 3 intervention groups.Choose 36 matching normal control persons,and let them finish PCS,ATQ and CSQ.Choose 18 CTTH patients as the group which wait for treatment, and let them finish BPI before and after the same time(8 weeks).Results1.PCS and ATQ of chronic tension-type headache patients are significantly higher than the value of normal person(p＜0.05).Comparing with the normal person, diverting attention is significantly lower in chronic tension-type headache patients(p＜0.05),increased behavioral activity are significantly higher in chronic tension-type headache patients(p＜0.05).2.The second scores of PCS are significantly lower than the first scores in CBT group and combination group(p＜0.01),and the difference is not significant in fluoxetine group(p＞0.05).The second scores of ATQ are significantly lower than the first scores in 3 intervention groups(p＜0.01).Comparing with the first results,the active coping strategies increase(p＜0.01) and the negative coping strategies decrease(p＜0.01) in combination group and CBT group.The change of diverting attention and catastrophizing are most significant in combination group(p＜0.01).Ignoring pain sensations and diverting attention increase significantly(p＜0.01),and increased behavioral activity and catastrophizing decrease significantly(p＜0.01) in CBT group.Both active and negative coping strategies decrease significantly(p＜0.05),and coping self-statements decrease most significantly(p＜0.01) in fluoxetine group.3.49 of 64 chronic tension-type headache patients accompany with depression, with the rate of 76.56%.41 of 64 patients accompany with anxiety,with the rate of 64.06%.36 of 64 patients accompany with anxiety and depression,with the rate of 56.25%.10 patients didn't accompany with anxiety or depression,4 of them accord with somatization disorder,with the rate of 6.25%,and all the other 6 patients accord with pain disorder accompany psychological factors,with the rate of 9.38%.The second scores of HAMD and HAMA are significantly lower than the first scores in the 3 groups(p＜0.05).The difference of HAMA significant efficiency and the difference of HAMD significant efficiency between the 3 intervention groups are not significant(p＞0.05).4.The second scores of BPI are significantly lower than the first scores in 3 intervention groups(p＜0.05).The reductive difference of BPI in combination group are higher than the value in CBT group significantly(p＜0.05).The difference of BPI at a distance of 8 weeks are not significant in the group which wait for treatment(p＞0.05).Conclusion1.CTTH patients have more negative automatic thoughts,pain catastrophizing, negative coping strategies for pain,and less active coping strategies for pain.2.The CBT which is to correct the unhealthy cognition and the coping strategies for pain can improve the cognition of CTTH patients,such as negative automatic thoughts,pain catastrophizing and coping strategies for pain.The improve effects of fluoxetine treatment to unhealthy cognition for pain is not clear.3.All of CBT,fluoxetine treatment and the combination treatment can improve the emotion and pain perception.The combination treatment can improve the pain perception better. |
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