Health Coaching for Chronic Multi-symptom Illness

慢性疼痛是我们社会面临的最广泛的卫生保健问题之一，对所有人都有严重影响 患者生活的各个方面”。疼痛为主的慢性多症状疾病（疼痛-CMI，例如， 纤维肌痛）是一种特别使人衰弱和难以治疗的慢性疼痛病症，并且是一种假定的 为1990年至2021年部署到海湾地区的退伍军人提供服务连接条件。VA/DoD 指南建议使用非药物治疗（例如，认知行为疗法）用于疼痛-CMI， 找到证据，他们改善残疾（通常）通过靶向疼痛-CMI的机制（例如，低 感知疼痛控制、灾难化和限制活动）。虽然没有单一的治疗是（或可能是） 可接受的，可用的和有效的所有退伍军人，有一个广泛的治疗选择，促进 退伍军人对非药物方法的吸收。健康指导是一种有吸引力的潜在方法， 改善Pain-CMI的残疾，因为它具有高可接受性，并且随着VA的广泛使用， 为其他条件推出健康指导（高可用性）。本提案的目的是了解， 健康指导对于复杂疼痛状况Pain-CMI也是有效。健康指导具有高 可接受性，因为它解决了专家，临床医生和患者一致认为的低满意度的驱动因素， 依从性-患者和提供者之间关于原因和最佳方法的分歧 疼痛-CMI。在健康教练中，健康教练会强调退伍军人的信念，并利用这些信念来制定一个共同的 了解Pain-CMI。然后，健康教练确定退伍军人生活中的差异， 和老兵想去的地方动机性面试、目标设定和解决问题的方法被用来 帮助退伍军人减少这些差异。目前提案的目标是进行一项随机 临床试验，以确定远程提供的健康指导，以减少残疾和疼痛的疗效 与支持性心理治疗（n=250）相比， 变化机制。退伍军人事务部已经为其他情况推出了整体健康指导方法。 因此，如果发现有效，我们的健康教练干预措施可以传授给退伍军人管理局的整体健康教练 全国供应商。这将增加获得照顾的退伍军人与疼痛-CMI。The VA WRIISC，28 由国会授权在CMI中提供领导和专业知识，正在密切关注我们的努力， 指导他们的决定和潜在的国家实施健康教练疼痛-CMI。有一个 迫切需要经验数据来指导这些决定。

Chronic pain is one of the most extensive health care issues facing our society with “severe impacts on all aspects of the lives of its sufferers.” Pain predominant chronic multisymptom illness (Pain-CMI, e.g., fibromyalgia) is a particularly debilitating and treatment resistant chronic pain condition and a presumptive service connected condition for Veterans who deployed to the Gulf region from 1990-2021. The VA/DoD Guidelines recommend non-pharmaceutical treatments (e.g., cognitive behavioral therapy) for Pain-CMI and find evidence they improve disability (typically) by targeting the mechanisms underlying Pain-CMI (e.g., low perceived pain control, catastrophizing and limiting activity). While no single treatment is (or is likely to be) acceptable, available and efficacious for all Veterans, having a wide array of treatment options facilitates Veterans’ uptake of non-pharmaceutical approaches. Health coaching is an appealing potential approach to improve the disability of Pain-CMI because it has high acceptability and it will be widely available as the VA is rolling out health coaching for other conditions (high availability). The goal of this proposal is to understand if health coaching is also efficacious for complex pain condition, Pain-CMI. Health coaching has high acceptability because it addresses what experts, clinicians and patients agree is a driver of low satisfaction and adherence - disagreement between the patient and providers about the cause of and best approaches for Pain-CMI. In health coaching, the health coach elicits the Veteran’s beliefs and uses these to develop a shared understanding of Pain-CMI. The health coach then identifies discrepancies between where in life the Veteran is and where the Veteran wants to be. Motivational interviewing, goal setting and problem-solving are used to help the Veteran reduce these discrepancies. The goal of the current proposal is to conduct a randomized clinical trial to determine the efficacy of remote-delivered health coaching to reduce the disability and pain impairment for Veterans with Pain-CMI as compared to supportive psychotherapy (n=250), and to explore mechanisms of change. The VA has already rolled out whole health coaching approaches for other conditions. Thus, if found to be efficacious, our health coaching intervention can be taught to VA whole health coaches and providers nationally. This would increase access to care for Veterans with Pain-CMI. The VA WRIISC,28 which is mandated by Congress to provide leadership and expertise in CMI, is closely following our efforts to guide their decisions and potential national implementation of health coaching for Pain-CMI. There is a desperate need for empirical data to guide these decisions.