Brief Cognitive Behavioral Therapy for Chronic Pain to Improve Functional Outcomes among Primary Care Veterans

针对慢性疼痛的简短认知行为疗法可改善初级保健退伍军人的功能结果

• 批准号: 10181325
• 负责人: Gregory P Beehler
• 金额: --
• 依托单位: VA WESTERN NEW YORK HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10181325
• 关键词: Address; Affect; Aftercare; Analgesics; Appointment; Behavior Therapy; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Chronic; Clinic; Clinical; Cognitive Therapy; Complement; Complex; Data; Demographic Factors; Distress; Early treatment; Educational process of instructing; Feeling suicidal; Funding; Goals; Guidelines; Health Personnel; Healthcare Systems; Intervention; Interview; Length; Life; Measures; Mediator of activation protein; Mental Health; Methods; Mission; Musculoskeletal Pain; New York; Opioid; Outcome; Pain; Pain Clinics; Pain Management Method; Pain intensity; Pain management; Participant; Patient Self-Report; Patient-Focused Outcomes; Patients; Personal Satisfaction; Positioning Attribute; Primary Health Care; Provider; Psychotherapy; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Recovery of Function; Reporting; Role; Self Efficacy; Services; Signal Transduction; Single-Blind Study; Statistical Data Interpretation; Structure; Testing; Therapeutic; Time; Veterans; arm; base; behavioral health; biopsychosocial; care providers; chronic musculoskeletal pain; chronic pain; chronic pain patient; clinically significant; cognitive skill; depressive symptoms; design; effective therapy; effectiveness trial; expectation; follow-up; functional disability; functional outcomes; functional status; improved; medical specialties; multidisciplinary; multilevel analysis; opioid therapy; primary care services; primary outcome; programs; psychologic; recruit; satisfaction; secondary outcome; skills; treatment as usual; treatment comparison

National guidelines, such as those from the Centers for Disease Control, recommend psychological therapies over opioid therapy as a preferred first line treatment for chronic pain. Behavioral health providers embedded in primary care as part of the VA’s national Primary Care-Mental Health Integration (PCMHI) program are well- positioned to support Veterans with pain by delivering treatments to improve functional recovery. Cognitive behavioral therapy for chronic pain is widely recognized as a safe and effective psychological treatment. However, this treatment is typically a lengthy psychotherapy (≥10, 50-minute sessions) designed for specialized care settings. In contrast, PCMHI services are brief and time-limited (≤6, 30-minute sessions) to be consistent with primary care services that treat a high volume of patients. To extend the reach of treatment to primary care Veterans who present with a pain concern, we have developed a PCMHI-based version titled Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP). Brief CBT-CP condenses content into only six sessions organized around the 30-minute appointment structure used by PCMHI providers. Brief CBT- CP was recently evaluated in a clinical demonstration project that found a statistically and clinically significant decrease in a composite measure of pain intensity and pain-related activity interreference following treatment. On average, the majority of improvement was achieved in the first three sessions of treatment signaling that Brief CBT-CP can potentially produce rapid clinical benefit. Our funded RR&D SPiRE (in progress) indicates the high feasibility of our trial methods as we frequently exceeded planned monthly recruitment goals with high retention. Additionally, patients have reported high levels of treatment satisfaction and PCMHI providers report that Brief CBT-CP is an important and feasible intervention. Based on these preliminary studies, this application proposes to conduct a single-blind, double-arm, randomized controlled trial among [178] Veterans with chronic musculoskeletal pain and pain-related functional impairment who receive primary care services at the VA Western New York Healthcare System. Veterans will be randomized to either (1) Brief CBT-CP and primary care treatment as usual (TAU) or (2) TAU only. Patient data will be collected at baseline, mid-treatment (6-week), post-treatment (12-week), and follow-up (6-month) to evaluate through multilevel modeling if Brief CBT-CP produces a rapid decrease in pain-related activity interference (primary outcome). Secondary clinical outcomes (pain intensity, depression symptoms, suicidal ideation, quality of life, and social role engagement) will be assessed in the same manner. The second goal of the study is to assess potential treatment mediators (i.e., pain self-efficacy and catastrophizing) and moderators (i.e., demographic factors, treatment expectations, opioid and adjunctive treatment use, therapeutic alliance) to determine if these factors impact outcomes. The third aim of the study incorporates a mixed methods component by including qualitative interviews with patients to illuminate how Brief CBT-CP contributes to improvement in functional status and improved life role engagement. This study is well-aligned with the mission of RR&D and supports the VA clinical goals nationally by promoting a safe, accessible, non-pharmacological treatment for chronic pain early in the trajectory of care.

国家指南，例如疾病控制中心的指南，推荐心理治疗 超过阿片类药物治疗作为慢性疼痛的首选一线治疗方法。行为健康提供者嵌入 作为退伍军人管理局国家初级保健-心理健康一体化 (PCMHI) 计划一部分的初级保健是很好的- 旨在通过提供改善功能恢复的治疗来支持患有疼痛的退伍军人。认知的 慢性疼痛的行为疗法被广泛认为是一种安全有效的心理治疗方法。 然而，这种治疗通常是一种漫长的心理治疗（≥10次，50分钟的疗程），专为 专门的护理机构。相比之下，PCMHI 服务简短且有时间限制（≤6 个，30 分钟的会话） 与治疗大量患者的初级保健服务一致。为了扩大治疗范围 初级保健 对于有疼痛问题的退伍军人，我们开发了一个基于 PCMHI 的版本，名为 慢性疼痛的简短认知行为疗法（简短的 CBT-CP）。简短的 CBT-CP 将内容浓缩为 仅围绕 PCMHI 提供商使用的 30 分钟预约结构组织了六次会议。简短的 CBT- 最近在一个临床示范项目中对 CP 进行了评估，发现具有统计学和临床​​意义 治疗后疼痛强度和疼痛相关活动相互关联的综合测量值降低。 平均而言，大部分改善是在前三个疗程中实现的，这表明 简短的 CBT-CP 可能会产生快速的临床效益。我们资助的 RR&D SPiRE（正在进行中）表明 我们的试验方法具有很高的可行性，因为我们经常超出计划的每月招聘目标 保留。此外，患者报告了高水平的治疗满意度，PCMHI 提供者报告 简短的 CBT-CP 是一项重要且可行的干预措施。基于这些初步研究，本 申请建议在[178]退伍军人中进行单盲、双臂、随机对照试验 患有慢性肌肉骨骼疼痛和疼痛相关功能障碍并在以下地点接受初级保健服务的人 VA 纽约西部医疗系统。退伍军人将被随机分配到 (1) 简短 CBT-CP 和 照常初级保健治疗 (TAU) 或 (2) 仅 TAU。将在基线、治疗中期收集患者数据 （6 周）、治疗后（12 周）和随访（6 个月），通过多层次模型评估是否简短 CBT-CP 可以快速减少与疼痛相关的活动干扰（主要结果）。二级临床 结果（疼痛强度、抑郁症状、自杀意念、生活质量和社会角色参与度） 将以同样的方式进行评估。该研究的第二个目标是评估潜在的治疗介质 （即疼痛自我效能和灾难化）和调节因素（即人口因素、治疗期望、 阿片类药物和辅助治疗的使用、治疗联盟）以确定这些因素是否影响结果。这 该研究的第三个目标是采用混合方法，包括对患者进行定性访谈 阐明Brief CBT-CP 如何有助于改善功能状态和改善生活角色 订婚。这项研究与 RR&D 的使命非常一致，并支持 VA 在全国范围内的临床目标 在护理过程的早期促进对慢性疼痛的安全、可及、非药物治疗。