Web-based CBT for Opioid-treated, Chronic Pain Patients with Aberrant Behavior

描述（由申请人提供）：尽管阿片类药物治疗作为慢性非恶性疼痛（CNMP）患者的治疗方法越来越被接受，但在实现治疗目标（减轻疼痛严重程度和疼痛干扰）和临床环境中药物误用/滥用（通常被描述为异常药物相关行为）方面的担忧仍然存在。社会心理方法（尤其是自我管理策略，如认知行为疗法[CBT]）已被发现对CNMP的治疗有效。然而，大多数慢性疼痛患者没有接受全面的社会心理干预，主要是由于开具阿片类药物的医生缺乏专业知识和时间。为了解决这一公共卫生问题，我们建议开发、实施和评估一种创新的CBT干预措施，用于治疗慢性疼痛，以适应正在服用阿片类药物和表现异常行为的患者的特定需求。据我们所知，计划中的项目将是第一个互动的、基于网络的项目，为这一人群提供全面的心理治疗。具体目标是：目标1：开发一种互动的，计算机传递的心理社会治疗慢性疼痛患者的异常药物相关行为。我们将修改我们先前开发和评估的治疗教育系统（TES）的内容，这是一个基于网络的计算机提供的治疗项目，用于治疗已证明有效的物质使用障碍患者，以适合慢性疼痛患者。计划中的TES项目将由24个模块组成，将从认知行为的角度出发，结合一套已被证明对慢性疼痛患者有效的技术，这些技术来自药物滥用文献的适应。通过与专家顾问和慢性疼痛患者的反复开发过程，我们将确定如何最好地呈现程序中的信息，并评估每个模块的可接受性，易用性，亲和力，有用性以及与慢性疼痛患者经验的相关性。目的2：评价计算机介入治疗慢性疼痛患者药物相关异常行为在慢性疼痛门诊治疗中的效果。慢性疼痛患者将随机接受：(1)照常治疗（TAU; n=55）；或(2)TAU加计算机传递的心理社会干预（n=55）。主要结局是疼痛严重程度、疼痛干扰行为和药物相关异常行为；次要结果包括药物滥用、其他疼痛行为以及身体和情感功能。目的3：研究两种假设的治疗机制，以调解CBT TES干预与行为结果之间的关系：(1)与有效的疼痛管理和应对相关的认知扭曲（例如，无助感）；(2)对未来的期望。这一建议的基于网络的干预有可能通过广泛使用基于证据的慢性疼痛CBT来显著改善慢性疼痛的治疗。基于web的疼痛认知行为治疗摘要

DESCRIPTION (provided by applicant): Although opioid therapy has gained increasing acceptance as a treatment for patients with chronic non-malignant pain (CNMP), concerns persist related to achievement of treatment goals (reduction in pain severity and pain interference) and medication misuse/abuse within the clinical context (often described as aberrant drug related behavior). Psychosocial approaches (particularly self-management strategies such as cognitive-behavior therapy [CBT]) have been found to be efficacious for the treatment of CNMP. However, most chronic pain patients are not exposed to comprehensive psychosocial interventions, largely due to the lack of expertise and time among physicians who prescribe opioids. To address this public health concern, we propose to develop, implement, and evaluate an innovative CBT intervention for the treatment of chronic pain tailored to the specific needs of patients who are being prescribed opioids and who present with aberrant behaviors. To our knowledge, the planned program will be the first interactive, web- based program to provide comprehensive, psychosocial treatment to this population. The specific aims are: Aim 1: Develop an interactive, computer-delivered psychosocial treatment for chronic pain patients with aberrant drug-related behavior. We will modify the content of our previously developed and evaluated Therapeutic Education System (TES), a web-based computer-delivered therapy program for individuals with substance use disorders of demonstrated efficacy, to be appropriate for a population of chronic pain patients. The planned TES program will consist of 24 modules and will be theoretically grounded in the cognitive- behavioral perspective, incorporating a set of techniques that have been shown to be effective for chronic pain patients with adaptations from the substance abuse literature. Through an iterative development process with both expert consultants and chronic pain patients, we will determine how to best present the information in the program and assess each module's acceptability, ease of use, likeability, helpfulness, and relevance to the experience of chronic pain patients. AIM 2: Evaluate the efficacy of the computer-delivered intervention with chronic pain patients with aberrant drug-related behavior in outpatient treatment for chronic pain. Chronic pain patients will be randomized to receive either: (1) treatment as usual (TAU; n=55); or (2) TAU plus the computer-delivered psychosocial intervention (n=55). Primary outcomes are pain severity, pain interference behaviors, and drug-related aberrant behavior; secondary outcomes include substance misuse, other pain behaviors, and physical and emotional functioning. AIM 3: Examine two therapeutic mechanisms hypothesized to mediate the relationship between the CBT TES intervention and behavioral outcomes: (1) cognitive distortions (e.g., helplessness) relevant to effective pain management and coping and; (2) expectations about the future. This proposed web-based intervention has the potential to markedly improve the treatment of chronic pain by enabling widespread access to evidence-based CBT for chronic pain. Abstract for Web-based CBT for pain grant-FINAL.doc