Efficacy of Mind-Body Approaches for the Treatment of Chronic Pain with Psychological Comorbidity

身心方法治疗伴有心理共病的慢性疼痛的疗效

• 批准号: 10394794
• 负责人: Anne Malaktaris
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10394794
• 关键词: Affect; Aftercare; Anger; Anxiety; Anxiety Disorders; Area; Attention; Biometry; Caring; Chronic; Clinic; Clinical; Clinical Trials; Cognitive; Cognitive Therapy; Compassion; Complementary Health; Complex; Control Groups; Data; Data Analyses; Depression and Suicide; Depressive disorder; Development; Disease; Drops; Educational Status; Enrollment; Feeling suicidal; Future; Goals; Gold; Health; Health Care Costs; Health education; Healthcare Systems; Immune response; Institution; Integrative Medicine; Intervention; Intervention Studies; Lead; Life; Meditation; Mental Depression; Mental Health; Mentors; Mentorship; Mind-Body Intervention; Musculoskeletal; Musculoskeletal Pain; Non-Malignant; Opioid; Outcome; Pain; Pain Measurement; Pain interference; Patient Care; Patients; Personal Satisfaction; Pharmaceutical Preparations; Physical Function; Policies; Population; Post-Traumatic Stress Disorders; Protocols documentation; Psychotherapy; Public Health; Quality of life; Randomized Controlled Trials; Reporting; Research; Research Personnel; Sampling; Scientist; Severities; Site; Social Functioning; Strategic Planning; Stress; Suicide; Suicide prevention; Sum; Symptoms; Syndrome; Theoretical model; Training; Treatment outcome; Veterans; Veterans Health Administration; Work; anxiety symptoms; base; career; chronic pain; chronic pain management; chronic painful condition; clinical effect; clinical practice; clinical trial implementation; comorbidity; cost; depressive symptoms; disability; economic cost; efficacy evaluation; epidemiology study; evidence base; experience; follow-up; health related quality of life; implementation study; improved; interest; medical schools; mindfulness; negative affect; negative mood; novel; opioid misuse; pain catastrophizing; pain relief; physical conditioning; positive emotional state; psychoeducation; psychologic; psychological distress; psychosocial; recruit; reducing suicide; safety and feasibility; satisfaction; scaffold; social; societal costs; suicidal risk; suicide rate; training opportunity; treatment effect; treatment response; trial design; underserved area

Chronic pain (CP), defined as persistent (>6 months), non-malignant, musculoskeletal or generalized pain, is a prevalent and costly public health problem. CP is highly prevalent among Veterans; 30-40% of Veterans have moderate to severe CP. CP has a significant negative impact on mental health and quality of life. CP is associated with declines in physical and social functioning, decreased activity levels, anxiety, negative mood, and depression. Approximately 1.6 million Veterans Health Administration (VHA) enrolled Veterans have CP and psychological distress associated with mental health comorbidities, including posttraumatic stress disorder (PTSD; ~50%), depression (~25%), and anxiety disorder(s) (~25%). Despite this urgent clinical need and extraordinary economic and societal costs, there are currently no evidence-based psychosocial interventions that simultaneously target comorbid mental health symptoms and CP interference in Veterans. The proposed CDA-2 will include a randomized controlled trial (RCT) to evaluate the efficacy of Cognitively-Based Compassion Training for Chronic Pain with Psychological Comorbidity (CBCT-CP+). The trial will compare CBCT-CP+ to Health Education while Living with Pain (H.E.L.P.) control condition, in a sample of 126 Veterans with CP conditions and psychological comorbidities at the VA San Diego Healthcare System (VASDHS). The rationale for the proposed study of compassion meditation for CP with psychological comorbidity is motivated by (1) a pressing clinical need, (2) a clear theoretical model, and (3) initial evidence of its safety, feasibility and potential positive clinical effect for improving psychiatric conditions among Veterans. This research is of direct relevance to multiple VA stakeholders (i.e., investigating the efficacy of complementary and integrative health approaches for the treatment of complex physical and mental health problems). Findings from the proposed RCT will inform clinical practice and policy by investigating whether a compassion-based intervention targeting both CP and psychological comorbidities will improve treatment outcomes for Veterans. The proposed CDA-2 will provide me with an important training opportunity to merge my primary research interests and areas of expertise (psychosocial interventions for chronic pain and related mental health conditions and complementary and integrative health approaches, including meditation). I will be mentored by leading experts who specialize in CP treatment and assessment, RCT design and implementation, complementary and integrative health approaches, particularly meditation, mechanisms of meditation-based pain relief, and biostatistics. The proposed work will be conducted within a leading VA research center (VASDHS) and world-renowned research institution (UCSD School of Medicine). The proposed trial will also allow me to obtain the necessary training for achievement of my long-term goal to become an independent researcher within VA. Scaffolded training and mentorship in RCT design and execution and biostatistics, advanced training in complementary and integrative health approaches, and professional development will help propel me to independence as a VA intervention research scientist. Finally, results of the trial will lay the groundwork for multi-site studies that would attempt to determine efficacy of CBCT-CP+ across VA clinics and formally investigate putative mechanisms of treatment effects. This work could ultimately lead to better care for Veterans, greater patient and therapist satisfaction, and lower costs to VA.

慢性疼痛（CP），定义为持续性（>6个月）、非恶性、肌肉骨骼或全身性疼痛 疼痛是一个普遍的和昂贵的公共卫生问题。CP在退伍军人中非常普遍; 30-40%的 退伍军人有中度至重度CP。CP对心理健康和生活质量有显著的负面影响。 生活CP与身体和社会功能的下降、活动水平降低、焦虑、 消极情绪和抑郁大约160万退伍军人健康管理局（VHA）注册 退伍军人患有与精神健康共病相关的CP和心理困扰，包括 创伤后应激障碍（PTSD; ~50%）、抑郁症（~25%）和焦虑症（~25%）。尽管如此 迫切的临床需求和非凡的经济和社会成本，目前没有证据为基础的 同时针对共病心理健康症状和CP干预的心理社会干预， 老兵 拟议的CDA-2将包括一项随机对照试验（RCT），以评估 基于认知的慢性疼痛与心理障碍的复合训练（CBCT-CP+）。的 试验将比较CBCT-CP+与健康教育，而生活与疼痛（H. E. L. P.）控制条件下， 在VA San Diego Healthcare的126名患有CP疾病和心理共病的退伍军人样本 系统（VASDHS）。提出的对CP进行同情冥想的研究的基本原理， 合并症的动机是（1）迫切的临床需求，（2）明确的理论模型，（3） 它的安全性，可行性和潜在的积极的临床效果，以改善退伍军人的精神状况。 这项研究与多个VA利益相关者直接相关（即，研究 治疗复杂的身心健康的互补和综合保健方法 问题）。拟议RCT的结果将通过调查是否存在 针对CP和心理共病的基于同情的干预将改善治疗 退伍军人的成果。 拟议的CDA-2将为我提供一个重要的培训机会， 研究兴趣和专业领域（慢性疼痛和相关心理健康的心理社会干预 条件和补充和综合健康方法，包括冥想）。我将接受 专注于CP治疗和评估，RCT设计和实施的领先专家， 补充和综合的健康方法，特别是冥想，基于冥想的机制 止痛和生物统计学拟议的工作将在一个领先的VA研究中心进行 （VASDHS）和世界著名的研究机构（UCSD医学院）。 拟议的试验还将使我获得必要的培训，以实现我的长期目标。 我的目标是成为一名独立的研究员。RCT中的支架式培训和指导 设计和执行以及生物统计学，补充和综合卫生方法的高级培训， 和专业发展将有助于推动我独立作为一个退伍军人事务部干预研究科学家。 最后，试验结果将为多中心研究奠定基础，这些研究将试图确定疗效 CBCT-CP+在VA诊所中的应用，并正式研究治疗效果的假定机制。这项工作 最终可能会为退伍军人提供更好的护理，提高患者和治疗师的满意度，并降低成本， 弗吉尼亚