CBT and Exercise to Reduce Pain and Substance Use in Older Adults with HIV

描述（由申请人提供）：由于艾滋病毒治疗效果的改善和该年龄组新诊断感染率的增加，老年艾滋病毒感染者人数不断增加。慢性疼痛和药物滥用是艾滋病毒感染者普遍存在的医疗状况。首先，疼痛状况，如周围神经病变和相关残疾，在长期感染艾滋病毒的人群中很常见。其次，年龄的增长与骨关节炎和其他肌肉骨骼疾病（如背痛）等疼痛疾病的发病率增加有关。第三，药物滥用在艾滋病毒感染者中很常见，并使这一人群的慢性疼痛治疗复杂化。对于同时患有慢性疼痛和药物滥用的艾滋病毒感染者，综合治疗方法可能比单独治疗每种疾病更有益，加强自我管理的行为方法可以最大限度地减少止痛药的使用（对于已经与药物滥用和多种药物滥用作斗争的人来说，这是一种较好的策略）。此外，慢性疼痛经常导致活动受限和相应的功能下降，除了疼痛和药物使用外，还需要针对功能损伤的干预措施。运动已被证明可以减轻疼痛，提高身体机能、信心和情绪。对于同时使用药物的患者，运动的好处可能会减少药物的使用。该研究建议结合两种基于证据的行为疗法，治疗慢性疼痛的CBT和治疗药物滥用的CBT，以及在小组环境中进行锻炼，灵活性和平衡干预，太极（EX）。动机强化信息传递是一种在其他研究中证明有用的方法，用于解决药物滥用和疼痛控制，将用于提高综合干预的有效性。为了进行拟议的研究，我们将与核心社区卫生中心（CCHC）合作，这是一家非营利性的社区卫生中心，自1987年以来，该中心一直为加利福尼亚州洛杉矶的一个种族和种族多样化的社区提供精神健康、药物滥用和（最近）全面的艾滋病毒医疗服务。拟议方案的目标是减少疼痛感知，疼痛相关的残疾和物质使用的老年人，艾滋病毒感染的成年人慢性疼痛和物质滥用。本研究的长期目标是开发一种有效的干预措施，以改善感染艾滋病毒的老年人的慢性疼痛和药物滥用，这种干预措施可以通过社区卫生中心为感染艾滋病毒的老年人提供服务。

DESCRIPTION (provided by applicant): Older adults with HIV are a growing population due to improvements in both HIV treatment efficacy and increasing rates of newly-diagnosed infections in this age group. Chronic pain and substance abuse are prevalent medical conditions in HIV-infected persons. First, painful conditions such as peripheral neuropathy and associated disability are common among those living with long-term HIV infection. Second, advancing age is associated with increasing rates of painful conditions such as osteoarthritis and other musculoskeletal conditions (e.g., back pain). Third, substance abuse is common among persons living with HIV and complicates the treatment of chronic pain in this population. For HIV-infected persons with both chronic pain and substance abuse, an integrated treatment approach is more likely to be of benefit than treating each disorder separately, and a behavioral approach that reinforces self-management could minimize usage of pain medication (a preferable strategy for persons already struggling with substance abuse and polypharmacy). Additionally, chronic pain frequently leads to activity restriction and corresponding functional decline, and interventions that target functional impairment in addition to pain and substance use are needed. Exercise has been shown to decrease pain and improve functional capacity, confidence and mood. In patients who also use substances, the benefits of exercise may result in reduced substance use. The study proposed seeks to combine two evidence-based behavioral therapies, CBT for chronic pain and CBT for substance abuse, and an exercise, flexibility and balance intervention, tai chi, (EX) to be delivered in a group setting. Motivationa reinforcement messaging, a method proven useful in other studies addressing substance abuse and pain control, will be used to enhance the efficacy of the integrated intervention. To conduct the proposed study, we will partner with Core Community Health Center (CCHC), a non-profit, community-based health center that has provided mental health, substance abuse, and (more recently) comprehensive HIV medical care to an ethnically and racially diverse community in Los Angeles, CA since 1987. The goals of the proposed program are to decrease pain perception, pain-related disability and substance use for older, HIV-infected adults with chronic pain and substance abuse. The long-term goal of this research is to develop an effective intervention to improve chronic pain and substance abuse among older adults living with HIV that can be feasibly delivered by community-based health centers serving aging adults with HIV infection.