Preventing Persistent Post-Surgical Pain and Dysfunction in At-Risk Veterans: Effect of a Brief Behavioral Intervention

持续性术后疼痛（PPSP）和功能受损在接受手术的患者中很常见。 全膝关节镜（TKA）。疼痛持续超过预期的愈合期可能是毁灭性的， 一个人的幸福感事实上，疼痛的严重程度与对身体功能的不良影响高度相关。 强有力和一致的证据表明，具有高度焦虑和/或抑郁症状（痛苦）的患者 有PPSP的风险。退伍军人术后问题的风险特别高，因为 80%的人在手术前经历过某种程度的心理困扰，50%的人报告在手术前经历过疼痛。 定期.预定手术是医疗保健系统的一个关键时刻， 有机会发现和解决这些问题。接受和承诺疗法（ACT）是一种跨- 抑郁症、焦虑症和慢性疼痛的诊断和循证治疗。重要的是，ACT一直是 以各种治疗形式有效实施，包括为期一天的密集小组讲习班。 本申请提出了一项多中心、双盲、两组、平行、随机对照试验 比较ACT干预与注意力控制（AC）干预对有风险的退伍军人的影响， TKA后PPSP。在TKA之前具有高度疼痛和显著痛苦的退伍军人将被确定为 “有危险”本研究的主要目的是检查ACT与AC相比对疼痛的疗效， TKA术后6周、3个月和6个月时，处于风险中的退伍军人的功能。第二个目的是检查 与AC相比，ACT对抑郁和焦虑症状以及应对技能的影响。调解 将进行分析，以检查抑郁、焦虑和应对技能的变化是否与抑郁、焦虑和应对技能有关。 对疼痛和功能的影响。最后，我们将探讨目前阿片类药物限制对使用的影响。 TKA后的药物和非药物疼痛管理策略。现时的建议 基于R34资助的初步研究的有希望的结果。 在手术前为患有抑郁和焦虑症状的人提供这种治疗， 预防PPSP和术后功能受损的目的是创新的。它有可能 将临床实践从关注术后疼痛的管理转变为预防慢性疼痛， 风险个人。该项目采用跨学科的方法来照顾退伍军人， 显著影响退伍军人生活质量和医疗保健的术后后遗症的主要风险因素 利用率因此，它有可能转化为已知的有效治疗痛苦的方法， 慢性疼痛，以防止手术效果不佳。该格式是简短和创新的，提供了最佳的潜力， 治疗依从性、参与者的可接受性和实践环境的广泛部署。最后，这更 集中和有时间限制的方法允许在很短的时间内完成，例如在 手术

Persistent post-surgical pain (PPSP) and impaired functioning are common among patients undergoing total knee arthroscopy (TKA). Pain that persists beyond the expected period of healing can be devastating to one's sense of well-being. In fact, pain severity is highly correlated with adverse effects on physical functioning. Strong and consistent evidence indicates that patients with high anxiety and/or depressive symptoms (distress) prior to surgery are at risk for PPSP. Veterans are at particularly high risk for post-surgical problems because 80% experience some level of psychological distress prior to surgery and 50% report experiencing pain on a regular basis. Scheduled surgery is a critical juncture with the healthcare system that provides an important opportunity to identify and address these issues. Acceptance and Commitment Therapy (ACT) is a trans- diagnostic and evidence-based treatment for depression, anxiety, and chronic pain. Importantly, ACT has been effectively implemented in various treatment-delivery formats, including intensive 1-day group workshops. This application proposes a multi-site, double-blind, two-arm, parallel, randomized controlled trial comparing the effects of an ACT intervention to an attention control (AC) intervention in Veterans at-risk for PPSP following TKA. Veterans with high levels of pain and significant distress prior to TKA will be identified as “at-risk.” The primary aim of this study is to examine the efficacy of ACT compared to AC on pain and functioning in at-risk Veterans at 6 weeks, 3 and 6 months post-TKA. The secondary aim is to examine the effects of ACT, compared to AC, on depressive and anxiety symptoms and on coping skills. Mediation analyses will be conducted to examine whether changes in depression, anxiety, and coping skills have an impact on pain and functioning. Finally, we will explore the impact of the current opioid restrictions on the use of pharmacological and non-pharmacological pain management strategies following TKA. The current proposal builds on promising results from a R34-funded preliminary study. Providing this therapy prior to surgery for people struggling with depressive and anxiety symptoms, for the purpose of preventing PPSP and impaired functioning following surgery, is innovative. It has the potential to change clinical practice from a focus on management of postoperative pain to prevention of chronic pain in at- risk individuals. This project incorporates an interdisciplinary approach to the care of Veterans that attends to major risk factors of postoperative sequelae that significantly impact Veterans' quality of life and healthcare utilization. Thus, it has the potential to translate what is known about effective treatments of distress and chronic pain to prevent poor surgical outcomes. The format is brief and innovative, offering potential for optimal treatment adherence, participant acceptability, and broad deployment to practice settings. Finally, this more concentrated and time-limited approach allows for completion within a short window of time, such as before surgery.