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

描述(由申请人提供)：尽管阿片类药物疗法作为慢性非恶性疼痛(CNMP)患者的治疗方法已被越来越多地接受，但与实现治疗目标(减轻疼痛严重程度和疼痛干扰)以及临床背景下的药物滥用/滥用(通常被描述为异常药物相关行为)有关的担忧依然存在。心理社会方法(特别是自我管理策略，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心理社会干预，这主要是因为开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，该干预措施针对服用阿片类药物和出现异常行为的患者的特定需求。据我们所知，计划中的计划将是第一个互动的、基于网络的计划，为这一群体提供全面的心理社会治疗。具体目标是：目标1：为有异常药物相关行为的慢性疼痛患者开发一种交互式的、由计算机提供的心理社会治疗。我们将修改我们之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交付治疗程序，适用于已证明有效的物质使用障碍患者，以适合慢性疼痛患者群体。计划中的TES计划将由24个模块组成，理论上将以认知-行为角度为基础，纳入一套已被证明对慢性疼痛患者有效的技术，这些患者的适应来自药物滥用文献。通过与专家顾问和慢性疼痛患者的迭代开发过程，我们将确定如何最好地在程序中呈现信息，并评估每个模块的可接受性、易用性、亲和性、有助性和与慢性疼痛患者的体验的相关性。目的：评价计算机辅助干预在慢性疼痛门诊治疗中对药物相关行为异常患者的治疗效果。慢性疼痛患者将随机接受：(1)照常治疗(TAU；n=55)；或(2)TAU加电脑提供的心理社会干预(n=55)。主要结果是疼痛严重程度、疼痛干扰行为和与药物相关的异常行为；次要结果包括物质滥用、其他疼痛行为以及身体和情感功能。目的3：检验两种假想的治疗机制，以调节CBT-TES干预和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)对未来的预期。这一拟议的基于网络的干预措施有可能通过使慢性疼痛的循证CBT广泛获得而显著改善慢性疼痛的治疗。基于Web的基于CBT的疼痛赠款摘要-Final.doc.

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