Acceptance and commitment therapy to address the psychosocial co-morbidities of chronic pain in aging people living with HIV

接受和承诺疗法可解决老年艾滋病毒感染者慢性疼痛的心理社会并发症

• 批准号: 9762827
• 负责人: Maile Ann Young Karris
• 金额: $ 11.81万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9762827
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adverse effects; Affect; Age; Aging; Alcohol or Other Drugs use; Behavior; Case Manager; Clinic; Cognitive Therapy; Cognitive deficits; Communities; Comorbidity; Dangerousness; Data; Degenerative polyarthritis; Delirium; Development; Development Plans; Disease; Education; Elderly; Emotional; Emotions; Evaluation; Exhibits; Feedback; Focus Groups; Future; Gastrointestinal Hemorrhage; Goals; Grant; HIV; HIV Seronegativity; HIV therapy; Health; Health Educators; High Prevalence; Human Resources; Impaired cognition; Impairment; Injecting drug user; Intervention; Investments; Life; Life Experience; Literature; Loneliness; Medical; Mental Depression; Methods; Modeling; Muscle relaxants; Non-Steroidal Anti-Inflammatory Agents; Outcome; Pain; Pain management; Participant; Patient Self-Report; Performance; Peripheral Nervous System; Persons; Pharmaceutical Preparations; Physical Function; Physical Performance; Population; Professional counselor; Psychosocial Factor; Psychotherapy; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Research; Risk; Severities; Skeletal Muscle; Social isolation; Stress; Substance abuse problem; Therapeutic Intervention; Thinking; Toxic effect; Training; Trauma; Treatment Efficacy; Treatment outcome; Uncontrolled Study; antiretroviral therapy; career; chronic pain; coping; experience; fall risk; falls; gender minority; health disparity; improved; mental state; mortality; negative affect; neurotoxicity; non-cancer chronic pain; novel; opioid misuse; opioid overdose; pain relief; pain symptom; prescription opioid misuse; primary outcome; programs; psychologic; psychosocial; racial minority; randomized trial; response; satisfaction; scale up; side effect; skills training; social stigma; socioeconomic disadvantage; treatment disparity

PROJECT SUMMARY/ABSTRACT Chronic pain affects a very high proportion of aging people living with HIV (aPLWH) and is thought to be related to both direct toxicity of HIV and antiretroviral therapy (ART) and by psychosocial factors that negatively affect pain (i.e. loneliness, HIV stigma). PLWH are also at increased risk for prescription opiate misuse. However as PLWH age, non-opiate medications used for pain can contribute to other negative outcomes such as falls, altered mental status and gastrointestinal bleeding. Thus there is a critical need for the development of novel interventions in the management of chronic pain in aPLWH that consider the psychological co- morbidities of aging with HIV and that can minimize the need for prescription medications. Acceptance and commitment therapy (ACT) has previously been evaluated in older persons with chronic pain and has demonstrated higher levels of satisfaction and efficacy when compared to cognitive behavioral therapy (CBT). ACT has never been evaluated in aPLWH for chronic pain, but has theoretical advantages over CBT for this population. Specifically several negatively modifying factors of CBT efficacy such as cognitive deficits are common in aPLWH. The overarching objective of this study is to determine the acceptability and feasibility of an ACT intervention for the management of chronic pain adapted to aPLWH. To accomplish this objective I will 1) train lay personnel to perform ACT to determine feasibility of this approach for future implementation, 2) conduct uncontrolled group ACT in aPLWH to generate participant feedback and questionnaire data to inform ACT adaption with the assistance of a steering commitee, and 3) conduct a pilot randomized controlled trial (RCT) evaluating the acceptability of adapted ACT compared to pain education. At completion of this grant we expect to have successfully trained lay personnel to perform group ACT, adapted ACT from quantitative and qualitative data collected from an uncontrolled study of group ACT, and determined whether ACT is acceptable and feasible as an intervention in aPLWH. These expected outcomes may benefit other aging populations with chronic pain that are enriched for psychosocial co-morbidities such as persons who inject drugs, the socioeconomically disadvantaged, and racial or gender minorities. This proposal is aligned with the Office of AIDS Research High Priorities to better understand “HIV-associated comorbidities” which includes pain and to “Reduce Health Disparities in treatment outcomes of those living with HIV/AIDS” and with the National Pain Strategy to “expand investment … in the development of safe and effective pain treatments.”

项目摘要/摘要 慢性疼痛影响着非常高比例的老年艾滋病毒携带者(APLWH)，被认为是 与艾滋病毒和抗逆转录病毒疗法(ART)的直接毒性以及与消极的心理社会因素有关 影响疼痛(即孤独、艾滋病毒污名)。PLWH滥用处方阿片类药物的风险也增加了。 然而，随着PLWH年龄的增长，用于止痛的非阿片类药物可能会导致其他负面结果，如 AS跌倒、精神状态改变和胃肠道出血。因此，迫切需要发展 APLWH慢性疼痛管理的新干预措施，考虑到心理协同作用 这可以减少对处方药的需求。接受和接受 承诺疗法(ACT)此前已在患有慢性疼痛的老年人中进行过评估，并已 与认知行为疗法(CBT)相比，显示出更高的满意度和有效性。 ACT从未在APLWH中用于慢性疼痛的评估，但在这方面比CBT有理论上的优势 人口。具体地说，CBT疗效的几个负面修正因素，如认知缺陷 在PLWH中常见。这项研究的总体目标是确定可接受性和可行性 ACT治疗慢性疼痛的干预措施适应于aPLWH。为了实现这一目标，我将 1)培训业外人员执行ACT，以确定该方法在未来实施的可行性；2) 在APLWH中进行非受控小组活动，以生成参与者反馈和调查问卷数据以供通知 在指导委员会的协助下进行ACT改编，以及3)进行试点随机对照试验 (RCT)与疼痛教育相比，评估适应的ACT的可接受性。在完成这笔赠款后，我们将 预期已成功培训非专业人员执行团体ACT，将ACT从量化和 从ACT组的非对照研究中收集定性数据，并确定ACT是否可接受 作为aPLWH的干预措施是可行的。这些预期的结果可能会使其他老龄化人口受益 慢性疼痛是由心理社会共病引起的，如注射毒品的人， 社会经济上的弱势群体，以及种族或性别少数群体。这项提议与联合国儿童基金会办公室保持一致 艾滋病研究的重中之重是更好地了解包括疼痛和 “减少艾滋病毒/艾滋病患者治疗结果中的健康差距”和“国家痛苦” “扩大投资…”战略在开发安全有效的疼痛治疗方法方面发挥了重要作用。

项目成果

Successful optimization of antiretroviral regimens in treatment-experienced people living with HIV undergoing liver transplantation.

在经历过治疗且接受肝移植的艾滋病毒感染者中成功优化抗逆转录病毒治疗方案。

• DOI: 10.1111/tid.13174
• 发表时间: 2019
• 期刊: Transplant infectious disease : an official journal of the Transplantation Society
• 作者: Waldman,Georgina;Rawlings,StephenA;Kerr,Janice;Vodkin,Irine;Aslam,Saima;Logan,Cathy;Dan,Jennifer;Mehta,Sanjay;Hill,Lucas;Karris,MaileY
• 通讯作者: Karris,MaileY