Resilience Skills Self-Management for Chronic Pain

慢性疼痛的自我管理弹性技能

• 批准号: 9900058
• 负责人: Afton L Hassett
• 金额: $ 51.03万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-09 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9900058
• 关键词: Activities of Daily Living; Address; Adult; Affect; Age; American; Anxiety; Back; Behavior; Behavior Therapy; Behavioral; Cardiovascular Diseases; Caring; Cell Aging; Chronic; Clinical; Cognitive; Cognitive Therapy; Coronary heart disease; Data; Development; Diabetes Mellitus; Disease; Effectiveness; Emotions; Fatigue; Fibromyalgia; General Practices; Genomics; HIV; Health; Health Professional; Healthcare Systems; Individual; Institute of Medicine (U.S.); Intervention; Lead; Length; Malignant Neoplasms; Mediating; Medical; Mental Depression; Moods; Neck; Online Systems; Outcome Study; Pain; Pain interference; Pain management; Patients; Persistent pain; Personal Satisfaction; Pharmaceutical Preparations; Physical Function; Play; Population; Positioning Attribute; Public Health; Quality of life; Randomized Controlled Trials; Recommendation; Reporting; Resources; Role; Self Management; Severities; Sleep; Specialist; Spine pain; Standardization; Surveys; Symptoms; Telephone; Telomerase; Telomere Shortening; Therapeutic Intervention; Training; age related; arm; base; chronic pain; chronic pain management; chronic pain patient; clinical practice; cognitive enhancement; comorbidity; cost; cost estimate; disability; evidence base; functional status; improved; indexing; innovation; loss of function; mortality; online resource; pain outcome; pain patient; pain self-management; pain symptom; painful neuropathy; positive emotional state; post intervention; practice setting; premature; primary outcome; profession allied to medicine; programs; psychological stressor; public health relevance; reduce symptoms; resilience; response; secondary outcome; self-management program; skills; symptomatic improvement; targeted treatment; telomere; treatment as usual; treatment group

PROJECT SUMMARY / ABSTRACT Chronic spinal pain is associated with loss of function and significant disability. When spine pain is comorbid with fibromyalgia, symptom severity and disability are amplified. Interventions capable of improving functional status, reducing symptoms, and enhancing well-being are critically needed. Both medications and cognitive- behavioral therapy (CBT) have demonstrated similar, modest effects for reducing symptoms in chronic pain. Behavioral treatments for chronic pain like CBT act predominantly by decreasing negative states rather than by Resilience-based interventions target the enhancement of positive emotions and well-being rather than focusing solely on negative emotions and behaviors. Although relatively under-used in chronic pain populations, resilience-based interventions have been used successfully in other clinical settings including depression, cardiovascular disease, diabetes, and HIV. promoting positive states associated with resilience. Thus, adding resilience-enhancing strategies to CBT for pain holds promise for further enhancing the effectiveness of CBT. In addition, most current behavioral interventions require specialized training and as such are not widely available. Medical assistants (MAs) are well-positioned in the healthcare system to play a pivotal role in helping individuals with chronic pain improve their functional abilities through innovative self-management strategies. The MA-led self-management programs proposed herein leverage the unique training and capabilities of MAs, while considering minimizing costs and maintaining the flow of clinical practice. The benefits of resilience- enhanced CBT that targets increasing patient well-being are also expected to extend beyond pain to potentially include genomic effects. Telomere shortening is predictive of disease and mortality and is considered an index for premature cellular aging. Our pilot data suggest that in addition to age and other physical and psychological stressors, inadequately managed pain can also affect telomere attrition. Thus, in addition to demonstrating the efficacy of online CBT self-management with resilience-enhancing activities (CBTRE), this application seeks to evaluate the impact of CBTRE on telomere health. Our central hypothesis is that our MA-supported CBTRE program will demonstrate superior efficacy to standard MA-supported online CBT self-management (eCBT) alone (Aim 1) through the enhancement of well-being (Aim 2). Both the CBTRE and eCBT interventions will improve telomere health with greater benefits being attributable to the CBTRE condition due to the mediating benefits of well-being (Aim 3). Therefore, we will conduct a randomized controlled trial of 300 individuals with spinal pain who also meet fibromyalgia criteria to investigate the effectiveness of the CBTRE program in promoting functional status, improved symptoms, and genomic health using resources already in most medical settings (i.e., MAs). By demonstrating the ability of this self-management intervention to improve physical function, pain and other symptoms, as well as telomere health, we hope to improve the options available for the care of millions of people who suffer with chronic spinal pain.

项目总结/摘要 慢性脊柱疼痛与功能丧失和严重残疾有关。当脊柱疼痛合并症时 在纤维肌痛中，症状的严重性和残疾被放大。能够改善功能的干预措施 状态，减少症状，并提高福祉是迫切需要的。包括药物治疗和认知- 行为疗法（CBT）已经证明了类似的，适度的效果，减少慢性疼痛的症状。 慢性疼痛的行为治疗，如CBT，主要是通过减少消极状态，而不是通过 基于复原力的干预措施旨在加强 积极的情绪和幸福感，而不是只关注消极的情绪和行为。虽然 在慢性疼痛人群中使用相对较少，但已成功使用了基于依从性的干预措施 在其他临床环境中，包括抑郁症，心血管疾病，糖尿病和艾滋病毒。 促进与复原力相关的积极状态。 因此，添加 增强CBT疼痛耐受性的策略有望进一步增强CBT的有效性。 此外，大多数当前的行为干预需要专门的培训，因此并不广泛。 available.医疗助理（MA）在医疗保健系统中处于有利地位，在帮助 患有慢性疼痛的个体通过创新的自我管理策略来改善他们的功能能力。 本文提出的MA主导的自我管理计划利用了MA的独特培训和能力， 同时考虑最小化成本和维持临床实践的流程。弹性的好处- 增强的CBT旨在增加患者的幸福感，预计也将超越疼痛， 包括基因组效应。端粒缩短是疾病和死亡率的预测指标， 细胞过早老化的原因我们的试验数据表明，除了年龄和其他生理和心理因素外， 压力源，管理不当的疼痛也会影响端粒磨损。因此，除了证明 为了提高在线CBT自我管理与复原力增强活动（CBTRE）的功效，该应用程序旨在 评估CBTRE对端粒健康的影响。我们的中心假设是，我们的MA支持的CBTRE 该计划将证明优于标准MA支持的在线CBT自我管理（eCBT）上级有效性 1、通过提高幸福感（Aim 2）。CBTRE和eCBT干预措施都将 改善端粒健康，更大的好处归因于CBTRE条件，由于介导 幸福（目标3）。因此，我们将对300名患者进行随机对照试验， 脊髓疼痛谁也符合纤维肌痛标准，以调查CBTRE计划的有效性， 促进功能状态，改善症状和基因组健康，利用大多数医学领域已有的资源， 设置（即，MA）。通过展示这种自我管理干预的能力， 功能，疼痛和其他症状，以及端粒的健康，我们希望改善的选择， 数百万慢性脊椎疼痛患者的护理。