Optimizing Response to Chronic Pain Treatments in Veterans: Identifying Key Moderators

项目摘要 慢性疼痛是一种普遍的致残性问题，影响多达50%的男性和75%的女性退伍军人。 最具经验支持的心理社会疼痛治疗是认知行为疗法（CBT）。 然而，并非所有人都能从CBT中受益。先前的研究表明，两个互补和整合 健康（CIH）干预，正念认知疗法（MBCT）和催眠认知疗法 （HYP-CT）是有益的，并提供CBT的替代品，具有相似的疗效。与CBT一样，个人 对这些治疗的反应也差别很大。我们的初步数据表明， 治疗结果可能是由于重要的基线患者差异。这表明， 患者可以有效地“匹配”到他们最有可能受益的治疗， 可以在治疗开始前获得的信息。需要进行研究以开发患者治疗方法 匹配算法，可以匹配一个给定的个人的循证治疗最有可能是 这是因为他们独特的个人形象。拟议研究的总体目标是通过以下方式满足这一需求 确定患者因素，确定谁从两种CIH治疗和目前的黄金中获益最多 标准非药物治疗（CBT），相对于常规护理。这一目标将通过一个 参与者将被随机分配到四种治疗条件之一的临床试验。我们将测试 假设-从理论和先前的试点研究发展-治疗前的大脑活动模式， 催眠、灾难化和正念调节治疗前后疼痛的改善 与常规护理相比，在患有糖尿病的退伍军人中， 慢性疼痛这些发现将为构建支持个性化护理的算法提供基础， 这样退伍军人就可以得到对他们最有利的治疗。这项研究也将有助于 发展有关潜在的强大的替代药物镇痛方法的知识。最后， 研究结果将有助医护人员和病人共同作出决定。

Project Summary Chronic pain is a prevalent, disabling problem affecting as many as 50% of men and 75% of women Veterans. The psychosocial pain treatment with the most empirical support is cognitive behavior therapy (CBT). However, not everyone benefits from CBT. Prior research has shown that two complementary and integrative health (CIH) interventions, Mindfulness-Based Cognitive Therapy (MBCT) and Hypnotic Cognitive Therapy (HYP-CT), are beneficial and offer alternatives to CBT and have similar efficacy. As with CBT, individual response to these treatments also varies considerably. Our preliminary data suggests the variability in treatment outcome may be due to important baseline patient differences. This suggests the possibility that patients can be effectively “matched” to the treatments they are most likely to benefit from, based on information that can be obtained before treatment starts. Research is needed to develop patient-treatment matching algorithms that could match a given individual to the evidence-based treatment most likely to be beneficial given their unique individual profile. The overall aim of the proposed study is to address this need by identifying patient factors that determine who benefits most from two CIH treatments and the current gold standard non-pharmacological treatment (CBT), relative to usual care. This aim will be addressed using a clinical trial in which participants will be randomized to one of the four treatment conditions. We will test hypotheses – developed from both theory and prior pilot research – that pre-treatment brain activity patterns, hypnotizability, catastrophizing, and mindfulness moderate pre- to post-treatment improvements in pain intensity associated with group-delivered CBT, MBCT, and HYP-CT, relative to usual care, in Veterans with chronic pain. The findings will provide the foundation for building an algorithm to support personalized care, whereby Veterans can be offered the treatment that will be most beneficial for them. This study will also help develop knowledge about potentially powerful alternatives to pharmacological analgesic approaches. Finally, the study findings will be useful to health care providers and their patients to facilitate shared decision-making.