Evaluation of the efficacy and mechanisms of a novel intervention for chronic pain tailored to people living with HIV

评估针对艾滋病毒感染者量身定制的慢性疼痛新型干预措施的功效和机制

• 批准号: 9922384
• 负责人: Jessica S Merlin
• 金额: $ 61.03万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-18 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922384
• 关键词: Academy; Accident and Emergency department; Acquired Immunodeficiency Syndrome; Address; Affect; Area; Behavior Therapy; Behavioral; Behavioral trial; Caring; Clinical; Collaborations; Disease; Ensure; Failure; Future; General Population; Goals; HIV; Health; Impairment; Informal Social Control; Intervention; K-Series Research Career Programs; Low Back Pain; Mediating; Mediator of activation protein; Medicine; Musculoskeletal Pain; Neurobiology; Neurofibromin 2; Normal tissue morphology; Opiate Addiction; Opioid; Outcome; Pain; Pain management; Participant; Patient Preferences; Patients; Persistent pain; Physical Function; Population; Prevalence; Primary Health Care; Process; Public Health; Quality of life; Randomized; Recording of previous events; Reporting; Research; Research Personnel; Research Priority; Self Efficacy; Severities; System; Testing; United States Dept. of Health and Human Services; United States National Institutes of Health; Vulnerable Populations; Work; addiction; antiretroviral therapy; arm; base; chronic pain; chronic pain management; comorbidity; depressive symptoms; efficacy evaluation; emotional functioning; expectation; experience; functional disability; healing; improved; improved functioning; innovation; mortality risk; novel; opioid epidemic; opioid overdose; pain self-management; painful neuropathy; peer; pilot trial; prescription opioid; randomized trial; skill acquisition; skills; social cognitive theory; success; theories; therapy development; treatment as usual; virology

Project Summary: Behavioral interventions for chronic pain among people living with HIV (PLWH) are an understudied area, with great potential to improve pain and function. Chronic pain is an important comorbidity that affects between 30% and 85% of PLWH and is associated with greater odds of functional impairment, increased emergency room utilization, suboptimal retention in HIV care, and failure to achieve virologic suppression. What is not known is how to optimally address chronic pain in this population. Opioids are a commonly used treatment for chronic pain, particularly in PLWH. Opioid prescribing for chronic pain often does not result in substantial improvement in outcomes and contributes to the growing epidemic of opioid addiction and overdose. In contrast, behavioral interventions are among the most effective and safest treatments for chronic pain in the general population. Pain Self-Management (PSM) is a Social Cognitive Theory (SCT)-based behavioral approach that involves pain-related skill acquisition and goal setting. PSM interventions have been promoted by the 2016 Department of Health and Human Services National Pain Strategy (DHHS NPS) as an effective, scalable approach to chronic pain management. Especially given the current opioid crisis, the DHHS NPS underscored the urgent need to develop and test PSM interventions tailored to the unique needs of vulnerable populations, particularly PLWH, that can be implemented and disseminated nationwide. Until an effective and scalable PSM intervention for chronic pain in PLWH is developed, reducing the burden of chronic pain safely and effectively in this population will not be possible. The overall objective of this proposal is to evaluate a novel theory-based PSM intervention, “Skills TO Manage Pain” (STOMP), developed for and tailored to PLWH. We will accomplish our overall objective with the following primary specific aim: 1) Evaluate the efficacy of STOMP, a theory-based intervention tailored to improving chronic pain in PLWH. Given our rigorous intervention development process and promising pilot trial results, our working hypothesis is that STOMP will decrease pain and improve function in PLWH. We also propose the following secondary aims: 2) Conduct exploratory analyses of the impact of STOMP on HIV outcomes associated with chronic pain (i.e. retention in care, virologic suppression), and 3) Investigate proximal outcomes as potential mediators of STOMP's impact on chronic pain. This approach is innovative because it incorporates novel peer co-led group sessions that were created based on our formative intervention development work, includes patients with comorbidities (e.g., depressive symptoms, addiction history) common among PLWH but typically excluded from chronic pain studies, and investigates the impact of a chronic pain intervention on disease-specific HIV outcomes in addition to pain and function. The proposed research will be significant because if successful, it will pave the way for future dissemination and implementation studies that have the potential to dramatically change chronic pain treatment for PLWH.

项目总结：针对HIV感染者慢性疼痛的行为干预是一项新的研究