Preventing Persistent Post-Surgical Pain & Opioid Use in Veterans: Effect of ACT

预防术后持续疼痛

• 批准号: 8748752
• 负责人: Barbara Rakel
• 金额: $ 33.98万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8748752
• 关键词: Acute; Address; Affect; Anxiety; Brief Pain Inventory; Caring; Cities; Data; Depressed mood; Distress; Educational process of instructing; Educational workshop; Environment; Equipment and supply inventories; Family; Feedback; Goals; Health; Healthcare Systems; Individual; Information Systems; Intervention; Interview; Iowa; Knowledge; Length; Life; Literature; Measurement; Measures; Mental Depression; Migraine; Military Personnel; Moods; Operative Surgical Procedures; Opioid; Orthopedic Surgery procedures; Outcome; Pain; Pain interference; Participant; Patient Outcomes Assessments; Patients; Persistent pain; Pilot Projects; Post-Traumatic Stress Disorders; Postoperative Pain; Prevention; Prevention therapy; Productivity; Psychological Factors; Psychology; Public Health; Quality of life; Randomized; Randomized Controlled Clinical Trials; Reporting; Request for Applications; Research; Risk; Risk Factors; Schedule; Sleep; Substance Use Disorder; Suggestion; Symptoms; Testing; Therapeutic Intervention; Training; Unemployment; United States National Institutes of Health; Veterans; Work; base; chronic pain; cognitive function; cost; design; disability; effective therapy; experience; high risk; improved; interdisciplinary approach; knee replacement arthroplasty; novel; prevent; primary outcome; psychologic; psychological distress; routine care; skills; social; suicidal risk; trait; treatment as usual; usability

A large number of veterans suffer from distress-based conditions, such as anxiety and depression, putting them at high risk of experiencing persistent pain and prolonged opioid use following surgery. These connections are based on strong and consistent evidence from the literature and our preliminary data. The proposed study adds a 1-day workshop of Acceptance and Commitment Therapy (ACT), followed by an individual “booster” session, to treatment as usual (TAU) to reduce veterans’ risk of persistent pain and prolonged opioid use following surgery. ACT has been shown to be effective in reducing chronic pain, anxiety and depression. This pilot study will establish the feasibility and preliminary efficacy of incorporating ACT into treatment as usual (TAU) to preoperatively target distress-based risk factors. Aim 1 is to establish the feasibility of successfully delivering ACT to at-risk veterans before and after surgery. Aim 2 is to test the preliminary efficacy of ACT on the length and/or amount of pain and opioid use after surgery. Veterans who are anxious or depressed before surgery will be randomly assigned to receive ACT plus TAU or TAU. Outcomes between the two groups will be compared. Aim 3 is to see if PROMIS modules, developed by the National Institute of Health, are useful for assessing pain and other symptoms in veterans. Findings from this study will be used to inform the design and implementation of a larger, well controlled, randomized clinical trial that will evaluate the efficacy of ACT plus TAU for at-risk veterans. This study will take place at the Iowa City VA Health Care System. Veterans scheduled for orthopedic surgery in 1 to 3 months who score high for anxiety or depression will be randomly assigned to attend a 1-day ACT workshop preoperatively, with an individualize “booster” session postoperatively, or to have TAU. Veterans who receive ACT and trainers who provide the treatment will be interviewed to identify barriers and facilitators to providing ACT to at-risk veterans before and after surgery. Other primary outcomes are pain and opioid use after surgery. Factors that may affect these outcomes will also be measured, including anxiety, depression, substance use disorder, post-traumatic stress disorder, and use of other pain meds. We expect to gain important knowledge about ways to best include ACT as part of routine care for veterans requiring surgery and about the preliminary efficacy of ACT for the prevention of persistent pain and prolonged opioid use following surgery.

大量退伍军人患有焦虑和抑郁等基于痛苦的疾病，这使他们在手术后经历持续疼痛和长时间使用阿片类药物的风险很高。这些联系是基于来自文献和我们的初步数据的有力和一致的证据。拟议的研究增加了一个为期一天的接受和承诺治疗（ACT）研讨会，随后是一个单独的“加强”会议，照常治疗（TAU），以减少退伍军人手术后持续疼痛和长期使用阿片类药物的风险。ACT已被证明在减轻慢性疼痛、焦虑和抑郁方面有效。这项试点研究将确定将ACT纳入常规治疗（TAU）的可行性和初步疗效，以术前针对基于痛苦的风险因素。目的1是确定在手术前后向高危退伍军人成功提供ACT的可行性。目的2是测试ACT对术后疼痛持续时间和/或数量以及阿片类药物使用的初步疗效。术前焦虑或抑郁的退伍军人将被随机分配接受ACT加TAU或TAU。比较两组的结果。第三个目标是观察由美国国立卫生研究院开发的PROMIS模块是否对评估退伍军人的疼痛和其他症状有用。这项研究的结果将用于设计和实施一项更大的、控制良好的随机临床试验，以评估ACT加TAU对高危退伍军人的疗效。这项研究将在爱荷华市退伍军人医疗保健系统进行。计划在1至3个月内进行骨科手术的焦虑或抑郁评分较高的退伍军人将被随机分配参加为期1天的ACT研讨会，并在术后进行个体化的“加强”会议，或进行TAU。接受ACT治疗的退伍军人和提供治疗的培训师将接受采访，以确定在手术前后向有风险的退伍军人提供ACT治疗的障碍和促进因素。其他主要结果是术后疼痛和阿片类药物的使用。可能影响这些结果的因素也将被测量，包括焦虑、抑郁、物质使用障碍、创伤后应激障碍和其他止痛药的使用。我们期望获得关于如何最好地将ACT作为需要手术的退伍军人常规护理的一部分的重要知识，以及ACT在预防手术后持续疼痛和长时间阿片类药物使用方面的初步功效。