ANXIETY, DEPRESSION, AND NONCARDIAC CHEST PAIN

申请人的描述：持续性疼痛是一个严重的问题，许多 非心源性胸痛患者。虽然应对技能培训（CST）方法 最近才被应用于非心源性胸痛的治疗， 这些方法似乎是有希望的。完成CST后，许多患者 报告疼痛显著减轻，身体和 心理社会残疾然而，后续研究的数据表明， 虽然一些患者能够在疼痛中保持治疗收益，但其他患者 没有鉴于CST的优点（成本低，副作用小）， 它所显示的前景，需要探索新的方法来帮助 非心源性胸痛患者维持并延长其初始治疗 收益.拟议中的研究旨在确定是否可以利用 通过与舍曲林结合来增强效果，舍曲林是一种精神药物， 最近在初步研究中发现， 非心源性胸痛患者。在拟议的研究中，200名非心脏胸部 疼痛患者将被随机分配到四个条件：a）CST + 舍曲林，B）CST加安慰剂，c）单独舍曲林，和d）单独安慰剂。 将在10周治疗期前后收集结局指标 研究结束后和治疗后6个月。研究：1）将评估 联合CST和舍他林的方案是否有助于患者维持 在疼痛、身体残疾、心理社会残疾方面的收益，以及2）意愿 确定患者疼痛相关的灾难性变化和日常使用 应对技能与长期（6个月）疼痛改善有关， 残疾。如果CST加舍曲林有效，未来的研究可以评估 这种生物行为方案对其他人群的有效性， 持续性疼痛（如骨关节炎、镰状细胞病或癌症）。未来 研究还可以确定国家技术服务小组的具体组成部分（例如： 注意力转移方法，行为应对策略，或认知 重组）对治疗效果贡献最大。通过隔离 这种训练的有效成分，一个人可以简化它。 成本效益高，因此更容易为广大人口提供 非心源性胸痛患者。这项研究提出了严格的评估 提高应对技能训练和舍曲林治疗抑郁症效果的方法 非心源性胸痛患者。这项研究可能会导致我们的重大进展， 了解非心源性胸痛并扩大我们的方法库 用于有效治疗非心源性胸痛。

APPLICANT'S DESCRIPTION: Persistent pain is a significant problem for many non-cardiac chest pain patients. Although coping skills training (CST) methods have only recently been applied to the management of non-cardiac chest pain, these methods appear to be promising. After completing CST, many patients report significant reductions in pain and improvements in physical and psychosocial disability. Data from follow-up studies, however, indicate that while some patients are able to maintain treatment gains in pain, others are not. Given the advantages of CST (its low cost and minimal side effects) and its demonstrated promise, there is a need to explore new ways to help non-cardiac chest pain patients maintain and extend their initial treatment gains. The proposed study seeks to determine whether the effects of CST can be enhanced by combing it with Sertraline-a psychotropic medication that we have recently found in preliminary research can significantly decrease pain in non-cardiac chest pain patients. In the proposed study, 200 non-cardiac chest pain patients will be randomly assigned to four conditions: a) CST plus Sertraline, b) CST plus placebo, c) Sertraline alone, and d) Placebo alone. Outcome measures will be collected before and after the 10 week treatment phase of the study and at 6-months post-treatment. The study: 1) will evaluate whether a protocol that combines CST with Sertaline helps patients maintain gains in pain, physical disability, psycholosocial disability, and 2) will determine how changes in patients' pain-related catastrophizing and daily use of coping skills relate to long-term (6 months) improvements in pain and disability. If CST plus Sertraline is effective, future studies could evaluate the efficacy of this biobehavioral protocol for other populations having persistent pain (e.g. osteoarthritis, sickle cell disease, or cancer). Future studies could also identify the particular components of CST (e.g. training in attention diversion methods, behavioral coping strategies, or cognitive restructuring) that contribute most to treatment effects. By isolating the active ingredients of this training, one can streamline it. making it more cost-effective and thus more readily available to the large population of non-cardiac chest pain patients. The study proposed rigorously evaluates methods for enhancing the effects of coping skills training and Sertraline in non-cardiac chest pain patients. This study may lead to major advances in our understanding of non-cardiac chest pain and enlarge our repertoire of methods for effectively treating non-cardiac chest pain.