Pilot Testing A Theory-Driven Self- Management Intervention for Chronic Musculoskeletal Pain

项目摘要 尽管有一系列的治疗方法，慢性肌肉骨骼疼痛（CMP）仍然是一个主要的健康问题。 问题.它是最常见的慢性疼痛类型，特别是在关节和背部，持续超过 正常愈合（3-6个月）。2016年，20%的美国成年人报告了慢性疼痛，其中8%的人 有限的生活活动。药物治疗是目前美国医学界治疗慢性疼痛的主要方法。 但这导致了目前的阿片类药物危机。 在我们之前的工作和经验教训的基础上，我们打算最大限度地提高阿帕的可用性和可访问性。 首先，我们将通过开发一个自我引导的移动的/支持Web的阿帕应用程序来改进我们以前的智能手机应用程序 （mAPA）版本，允许参与者访问阿帕信息， 并学会自我管理阿帕。mAPA将包括缩短的视频（约1分钟），以促进 微学习，并纳入生态瞬时评估，以监测遵守情况并实时捕获 疼痛结果和镇痛药的使用。然后，我们将通过一项3- 武装RCT：（1）自我指导mAPA，（2）面对面培训+ mAPA，和（3）等待名单的精神病护理控制。 两个mAPA组的受试者将继续接受常规护理， 对照组将在1个月随访后重新随机分配至任一mAPA组。与我们的飞行员相比 这是一项更大规模和更长期的RCT，将在马里兰州和内华达州进行，确保研究中心 将是包容性的，代表不同的人口。 我们的长期目标是消除疼痛护理差异，减少我们社会对阿片类药物的依赖， 痛苦利用技术，拟议的研究将有助于推进mAPA，一种新颖，易于启动，快速，安全， 和非药理学工具纳入自我管理计划，习惯性地管理现实世界中的疼痛 设置.

PROJECT SUMMARY Despite a range of therapeutic approaches, chronic musculoskeletal pain (CMP) continues to be a major health issue. It is the most common type of chronic pain, occurring particularly in the joints and back, lasting beyond normal healing (3-6 months). In 2016, 20% of American adults reported chronic pain and 8% of them had limited life activities. Pharmacotherapy is the predominant treatment for chronic pain in current US medical practice, but it has led to the current opioid crisis. Building upon our prior work and lessons learned, we intend to maximize the usability and accessibility of APA. First, we will advance our previous smartphone app by developing a self-guided mobile/web-enabled APA app (mAPA) version on a computer, tablet, or smartphone to allow participants to access APA information based on their preferences and learn to self-administer APA. mAPA will include shortened videos (~1 min) to facilitate micro-learning and incorporate ecological momentary assessment to monitor adherence and capture real-time pain outcomes and analgesic use. Then, we will evaluate the efficacy of mAPA on CMP outcomes through a 3- armed RCT: (1) Self-guided mAPA, (2) In-Person Training + mAPA, and (3) Wait-List Usual Care Control. Participants in the two mAPA groups will continue to receive usual care while participants in the Usual Care Control group will be re-randomized into either mAPA group after 1-month follow-up. Compared to our pilot study, this is a larger scale and longer term RCT to be conducted in Maryland and Nevada ensuring sites that will be inclusive and representative of diverse populations. Our long-term goal is to eliminate pain care disparities and reduce our society’s reliance on opioids to manage pain. Leveraging technology, the proposed study will help advance mAPA, a novel, easy-to-initiate, rapid, safe, and non-pharmacological tool incorporated in a self-management plan to habitually manage pain in real-world settings.