Mechanisms of Music Therapy to Palliate Pain in Patients with Advanced Cancer

音乐疗法缓解晚期癌症患者疼痛的机制

• 批准号: 9381161
• 负责人: Joke Bradt
• 金额: $ 44.26万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-27 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9381161
• 关键词: Address; Adrenergic Agents; Adult; Advanced Malignant Neoplasm; Adverse effects; Affect; Analgesics; Anxiety; Biological Markers; Characteristics; Chronic Cancer Pain; Clinical; Competence; Data; Development; Dopamine; Emotional; Esthesia; Expectancy; Fright; Goals; Hydrocortisone; Interdisciplinary Study; Intervention; Intervention Trial; Interview; Knowledge; Lead; Link; Malignant Neoplasms; Measures; Mediating; Mediation; Mediator of activation protein; Metastatic Neoplasm to the Bone; Methods; Modeling; Moods; Music; Music Therapy; Neoplasm Metastasis; Nucleus Accumbens; Outcome; Outpatients; Oxytocin; Pain; Pain intensity; Pain interference; Pain management; Palliative Care; Participant; Patient Self-Report; Patients; Pharmacological Treatment; Plasma; Play; Population; Public Health; Randomized; Randomized Controlled Trials; Reporting; Research; Research Methodology; Role; Salivary; Self Efficacy; Serum; Side; Stress; Structure; Surveys; Symptoms; Testing; Therapeutic; Time; Tweens; Work; advanced disease; anxiety reduction; arm; attentional control; base; beta-Endorphin; biopsychosocial; cancer care; cancer pain; chronic pain; daily functioning; efficacy trial; empowerment; endogenous opioids; experience; follow-up; innovation; palliate; palliation; pleasure; post intervention; psychosocial; social attention; symptom management; theories; therapy design; treatment response; ward

PROJECT SUMMARY/ABSTRACT This study addresses the public health problem of chronic pain as one of the most feared symptoms in people with cancer, with 70% to 90% of patients with advanced disease reporting pain. Unrelieved pain remains a challenge in cancer care. Insufficient relief from pharmacological treatments and the fear of side effects are important reasons for the growing use of complementary pain management approaches in people with cancer. One such approach is music therapy. Although efficacy of music therapy for pain has been established, there are no mechanistic studies clarifying how it works in clinical populations. Thus, there is a lack of knowledge related to 1) therapeutic mechanisms that lead to improvement (mediator effects) and 2) the relationship be- tween patient characteristics and treatment response (moderator effects). Yet, it is well accepted that knowledge of mediators and moderators as well as a validated theory of action (i.e., how the intervention acti- vates the mediators) are needed to optimize psychosocial treatment interventions. Therefore, the overarching goals of this study are to 1) examine mediators and moderators hypothesized to account for the pain-reducing effects of Interactive Music Therapy (IMT) in people with advanced cancer and chronic pain and 2) validate IMT's theory of action. The mediation model to be tested in this study aligns with a biopsychosocial framework to palliation of chronic pain and is based on findings from a preliminary study. We postulate that anxiety, mood, self-efficacy and perceived support mediate the effects of IMT on pain outcomes (i.e. pain intensity and pain interference). In addition, we will test the impact of several moderators on the hypothesized mediation model, namely adult playfulness, perceived musical competence, and treatment expectancy. This study uses a mixed methods intervention design in which qualitative data (i.e. semi-structured follow-up interviews) are embedded within a randomized controlled trial. We will randomize 100 outpatients with advanced cancer and chronic pain due to bone metastases to one of two 6-week treatments: 1) Interactive Music Therapy or 2) Social Attention Control. The mediators and pain outcomes will be measured at baseline, week 4 and week 6 using self-report measures as well as biomarkers (salivary cortisol, lachrymal dopamine content, serum oxytocin, and plasma β- endorphins). The follow-up interviews with a subsample of 20 participants will enable us to examine the con- gruence between the hypothesized mediators and moderators and participant explanations of how IMT influ- ences chronic pain management (i.e. theory of action). This study will contribute towards the optimization of music therapy for palliation of chronic pain in people with advanced cancer through a better understanding of the impact of mediators and moderators of IMT on chronic pain management. The results of this study will pro- vide estimated effects sizes of IMT on the mediators and preliminary effect size estimates for the pain out- comes. This information will be instrumental in the development of a subsequent large-scale efficacy trial.

项目摘要/摘要 这项研究解决了慢性疼痛的公共卫生问题，这是人们最喜欢的症状之一 患有癌症，有70％至90％的晚期疾病报告疼痛患者。不舒服的疼痛仍然是 癌症护理中的挑战。药物治疗的缓解不足和对副作用的恐惧是 在癌症患者中使用完善疼痛管理方法日益增长的重要原因。 一种这样的方法是音乐疗法。尽管已经建立了音乐疗法对疼痛的有效性，但 没有机械研究阐明它在临床人群中的工作方式。那，缺乏知识 与1）导致改善的治疗机制有关（介体效应）和2） 推文患者特征和治疗反应（主持人效应）。但是，很公认 对调解人和主持人以及经过验证的行动理论的了解（即干预如何行动 需要调解人）以优化社会心理治疗干预措施。因此，总体 这项研究的目标是1）假设减轻疼痛的考试调解人和主持人 交互式音乐疗法（IMT）对患有晚期癌症和慢性疼痛患者的影响以及2）验证 IMT的行动理论。在本研究中要测试的调解模型与生物心理社会框架保持一致 抚摸慢性疼痛，并基于初步研究的发现。我们假设焦虑，心情， 自效和感知的支持介导IMT对疼痛结果的影响（即疼痛强度和疼痛 干涉）。此外，我们将测试几个主持人对假设的调解模型的影响， 即成人的嬉戏，感知的音乐能力和治疗期望。这项研究使用了混合 定性数据（即半结构化后续访谈）的方法干预设计嵌入 在随机对照试验中。我们将使100名患有晚期癌症和慢性疼痛的门诊病人随机 由于骨转移对两个6周的治疗之一：1）互动音乐疗法或2）社会关注 控制。调解人和疼痛结果将在基线，第4周和第6周使用自我报告进行测量 措施和生物标志物（唾液皮质醇，lachrymal多巴胺含量，血清催产素和血浆β- 内啡肽）。与20名参与者的子样本进行的后续访谈将使我们能够检查 假设的调解人和主持人之间的兴趣以及IMT如何影响的参与解释 加密慢性疼痛管理（即作用理论）。这项研究将有助于优化 通过更好地理解晚期癌症患者慢性疼痛的音乐疗法 IMT的介体和主持人对慢性疼痛管理的影响。这项研究的结果将支持 视频估计IMT对介体的效果大小，以及疼痛的初步效应大小的估计值 该信息将有助于随后的大规模效率试验的开发。