Treating Chronic Pain and Depression in HIV Patients in Primary Care Settings

在初级保健机构中治疗艾滋病毒患者的慢性疼痛和抑郁症

• 批准号: 8502762
• 负责人: Michael D Stein
• 金额: $ 16.07万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-03 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8502762
• 关键词: Achievement; Address; Adherence; Affect; Anti-Retroviral Agents; Attention; Behavior Therapy; Behavioral; Caring; Chronic Disease; Clinical; Collaborations; Community Health Centers; Comorbidity; Complex; Consent; Data; Depressed mood; Future; Goals; Growth; HIV; HIV therapy; Health education; Home environment; Individual; Infection; Intervention; Joints; Lead; Manuals; Measures; Medical; Mental Depression; Mental Health; Mental disorders; Modeling; Nurses; Outcome; Pain; Pain interference; Participant; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Phase; Population; Preparation; Primary Care Physician; Primary Health Care; Private Practice; Procedures; Process; Process Assessment; Protocols documentation; Provider; Psychologist; Quality of life; Randomized; Randomized Clinical Trials; Relative (related person); Research; Research Design; Social Workers; Specialist; Supervision; Telephone; Testing; Training; Treatment outcome; Work; arm; behavioral health; chronic depression; chronic pain; depressive symptoms; disability; effective therapy; experience; improved; meetings; novel; pilot trial; primary care setting; primary outcome; public health relevance; secondary outcome; treatment planning

DESCRIPTION (provided by applicant): In the era of Highly Active Antiretroviral Treatment (HAART), HIV is increasingly a chronic illness. The experience of pain now often occurs over the entire course of infection, with 30-65% of HIV patients having chronic pain that is frequent, severe, may not be reversible, and interferes with daily activities. For most, no fully effective non-pharmacological therapies exist to improve pain outcomes. Developing a novel pain treatment is complicated by the fact that among HIV patients, pain often co- occurs with depression, one of the most common mental health disorders in HIV patients. This project will develop a collaborative treatment, in which behavioral health specialists (BHS: social workers, nurses, psychologists) and primary care providers (PCPs) share a unified plan for addressing pain and depression in patients receiving HIV care in a Community Health Center primary care setting. This collaborative therapy, entitled HIVPASS (HIV Pain And Sadness Study), builds upon behavior therapy that targets a reduction in behavioral avoidance and an increase in behavioral activation to address both conditions concurrently. Achievement of the Specific Aims will occur in the context of two phases. First, we will conduct an open trial of HIVPASS (n=10). Next, we will conduct a pilot randomized clinical trial (n=30) with two treatment arms, HIVPASS and Health Education. Pain will be the primary outcome variable assessed, and depression and antiretroviral adherence will be the secondary outcome variables. The Aims of this project are: 1. To develop and refine HIVPASS so that it meets standards of feasibility and acceptability for primary care physicians (PCPs), behavioral health specialists (BHSs), and participants (open trial and pilot RCT); a. To develop, field-test, and finalize a HIVPASS manual; b. To develop a reliable measure of BHS adherence to the manual; c. To develop, field-test, and finalize BHS training and supervision procedures; 2. To refine research procedures (e.g., consent process, randomization process, and assessment procedures), and establish their feasibility and acceptability to participants (pilot RCT) while confirming recruitment goal targets. This line of work could lead to the incorporation of theoretically-driven and effective treatment for patients with pain and depression into HIV care. This would be the first empirically-tested therapy protocol that specifically integrates treatment of these conditions in HIV research. We believe that this treatment will lead to improved pain and depression outcomes in population.

描述（由申请人提供）：在高效抗逆转录病毒治疗（HAART）时代，艾滋病毒越来越成为一种慢性疾病。疼痛的经历现在经常发生在整个感染过程中，30-65%的艾滋病毒患者患有慢性疼痛，这种疼痛是频繁的，严重的，可能是不可逆的，并干扰日常活动。对于大多数人来说，没有完全有效的非药物疗法来改善疼痛结局。开发一种新的疼痛治疗方法是复杂的，因为在艾滋病毒患者中，疼痛往往与抑郁症同时发生，抑郁症是艾滋病毒患者最常见的心理健康障碍之一。该项目将开发一种协作治疗，其中行为健康专家（BHS：社会工作者，护士，心理学家）和初级保健提供者（PCP）共享一个统一的计划，用于解决在社区卫生中心初级保健环境中接受艾滋病毒护理的患者的疼痛和抑郁症。这种名为HIVPASS（HIV疼痛和悲伤研究）的合作疗法建立在行为疗法的基础上，该疗法旨在减少行为回避和增加行为激活，以同时解决这两种情况。具体目标将分两个阶段实现。首先，我们将进行一项HIVPASS的开放试验（n=10）。接下来，我们将进行一项试点随机临床试验（n=30），有两个治疗组，HIVPASS和健康教育。疼痛将是评估的主要结局变量，抑郁和抗逆转录病毒治疗依从性将是次要结局变量。本项目的目标是：1。开发和完善HIVPASS，使其符合初级保健医生（PCP），行为健康专家（BHS）和参与者（开放试验和试点RCT）的可行性和可接受性标准; a.制定、现场测试和最终确定艾滋病毒通过手册; B.制定BHS遵守手册的可靠措施; c.制定、实地测试并最终确定BHS培训和监督程序;完善研究程序（例如，知情同意过程、随机化过程和评估程序），并在确认招募目标的同时确定其可行性和受试者的可接受性（试点RCT）。 这行 这项工作可能导致将理论驱动的有效治疗疼痛和抑郁患者纳入艾滋病毒护理。这将是第一个经过实验室测试的治疗方案，专门将这些疾病的治疗纳入艾滋病毒研究。我们相信，这种治疗将导致改善人群的疼痛和抑郁症的结果。

项目成果

Pilot Randomized Trial of Collaborative Behavioral Treatment for Chronic Pain and Depression in Persons Living with HIV/AIDS.

对艾滋病毒/艾滋病患者慢性疼痛和抑郁症进行协作行为治疗的随机试点试验。

• DOI: 10.1007/s10461-016-1397-7
• 发表时间: 2016
• 期刊: AIDS and behavior
• 影响因子: 4.4
• 作者: Uebelacker,LisaA;Weisberg,RisaB;Herman,DebraS;Bailey,GenieL;Pinkston-Camp,MeganM;Garnaat,SarahL;Stein,MichaelD
• 通讯作者: Stein,MichaelD