A BRIEF, TRANSDIAGNOSTIC COGNITIVE BEHAVIORAL TREATMENT FOR UROLOGIC CHRONIC PELVIC PAIN SYNDROME (UCPPS): PROCESS, PREDICTIONS, OUTCOMES

泌尿系统慢性盆腔疼痛综合征 (UCPPS) 的简短跨诊断认知行为治疗：过程、预测、结果

• 批准号: 10491127
• 负责人: JEFFREY M LACKNER
• 金额: $ 67.65万
• 依托单位: STATE UNIVERSITY OF NEW YORK AT BUFFALO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-21 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10491127
• 关键词: Acute; Address; Affect; Aftercare; Behavior Therapy; Behavioral; Behavioral trial; COVID-19; Chronic; Chronic Headaches; Chronic Prostatitis; Clinical; Cognition; Cognitive; Cognitive Science; Cognitive Therapy; Development; Diagnosis; Disease; Distress; Education; Evidence based treatment; Fatigue; Fibromyalgia; Foundations; Gender; Goals; Health; Impairment; Increased frequency of micturition; Individual; Informal Social Control; Interstitial Cystitis; Irritable Bowel Syndrome; Laboratories; Learning; Length; Mediating; Mediator of activation protein; Mission; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Pain; Pain management; Pathway interactions; Patient Preferences; Patients; Pelvic Pain; Phase; Phenotype; Policy Maker; Practice Guidelines; Procedures; Process; Provider; Public Health; Race; Randomized; Research; Research Personnel; Resources; Safety; Self Management; Sensory; Severities; Specificity; Statistical Models; Symptoms; Syndrome; Techniques; Testing; Time; United States National Institutes of Health; Woman; Work; arm; base; central pain; chronic pelvic pain; cognitive process; comorbidity; coping; cost; design; economic cost; efficacy evaluation; endophenotype; evidence base; flexibility; functional disability; health related quality of life; improved; innovation; interdisciplinary approach; men; non-drug; novel; novel therapeutics; pain catastrophizing; pain patient; patient engagement; persistent symptom; personalized medicine; primary endpoint; prognostic indicator; provider adoption; reduce symptoms; response; secondary endpoint; skills; social; symptom self management; symptomatic improvement; trait; treatment effect; treatment optimization; uptake; urinary; urologic chronic pelvic pain syndrome

Abstract/Project Summary Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated. Their prolonged personal and economic costs are amplified by the frequent co-occurrence of a cluster of centralized pain conditions (particularly irritable bowel syndrome 3 [IBS]) but also fibromyalgia [FMS], chronic headache, chronic fatigue, etc.) called Chronic Overlapping Pain Conditions (COPC). Clinically, the notion that these syndromes share a centralized pain phenotype with a fundamental disturbance in pain or sensory processing dovetails with our preliminary research showing that a novel transdiagnostic behavioral treatment emphasizing a single common mechanistic pathway (i.e. inflexible cognitive style) reduces severity of both targeted (IBS) and untargeted multisymptom COPCs that include (but is not limited to) to UCPPS, FMS, chronic fatigue, and chronic headache. If effective in a larger scale study, a transdiagnostic UCPPS treatment would offer a more efficient, accessible, and broadly useful strategy for improving chronic pelvic pain and its most frequent and complicating comorbidities. To this end, we will randomize 240 UCPPS subjects (18-70 yrs.) of any gender and race to a 4-session version of CBT that teaches skills for self-managing UCPPS symptoms (e.g. pelvic pain, urinary symptoms) with minimal clinician oversight (MC-CBT) or a four- session non-specific education/support control (EDU). Efficacy assessments will be administered at pre- treatment and two weeks after the end of the 10-week acute phase. We hypothesize MC-CBT will deliver significantly greater UCPPS symptom improvement than EDU (Aim 1). Additional aims include characterizing the durability of effects 3- and 6 months post treatment (Aim 2). To increase the efficacy and efficiency of behavioral pain treatments, we draw upon Beck’s transdiagnostic cognitive model13 to characterize the precise cognitive procedures and corresponding operative processes (e.g., cognitive distancing14, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT induced UCPPS symptom relief relative to EDU (Aim 3) as well as baseline patient variables that moderate differential response (Aim 3) with the ultimate goal of more proactive patient-treatment matching fundamental to the goals of personalized medicine. By applying innovative statistical modelling (e.g. dominance analysis, Randomized Explanatory Trial analyses) to study aims in the context of a rigorously designed behavioral trial, we expand the portfolio of nondrug pain treatments for UCPPS and co-aggregating COPCs to include one whose brevity, convenience, and transdiagnostic design “meets patients where they are”20 and addresses the practical (access, complexity, cost), clinical (breadth, durability, magnitude of effects, patient preference) and conceptual (untargeted comorbidities, non-pain somatic symptoms) challenges that have impeded uptake and public health impact of evidence-based behavioral pain treatments at a time when our most vulnerable high impact pain patients are in greatest need.

抽象/项目总结