Home-Based Self-Management of Chronic Pain in Adults with Sickle Cell Disease: Applying a Biopsychosocial and Technological Approach

镰状细胞病成人慢性疼痛的家庭自我管理：应用生物心理社会和技术方法

• 批准号: 10192113
• 负责人: Nadine Matthie
• 金额: $ 23.44万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-19 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10192113
• 关键词: Activities of Daily Living; Acute Pain; Address; Adult; Affect; African; Age; Analgesics; Anxiety; Area; Behavior; Behavioral; Biofeedback Training; Chronic; Clinical Treatment; Clinics and Hospitals; Cognitive; Cognitive Therapy; Collaborations; Complex Regional Pain Syndromes; Comprehensive Health Care; Computerized Medical Record; Confusion; Coping Behavior; Coping Skills; Data; Development; Devices; Disease; Education; Environment; Erythrocytes; Fibromyalgia; Focus Groups; Gold; Health; Healthcare Systems; High Prevalence; Home; Hospitalization; Hyperalgesia; Imagination; Immersion; Incidence; Individual; Inherited; Intervention; Interview; Lead; Learning; Low Back Pain; Measures; Mental Depression; Mental Health Services; Methods; Migraine; Modification; Morbidity - disease rate; Movement; Musculoskeletal Pain; Nature; Opioid; Outcome; Pain; Pain management; Participant; Pathway interactions; Pattern; Perception; Persons; Psychology; Publishing; Qualitative Methods; Quality of life; Randomized Controlled Trials; Reaction Time; Relaxation; Reporting; Safety; Self Efficacy; Self Management; Sickle Cell Anemia; Site; Sleep; Sleep disturbances; Surveys; Technology; Testing; Therapeutic; Time; Travel; United States; access restrictions; active control; base; biopsychosocial; black men; black women; burden of illness; chronic pain; chronic pain management; chronic painful condition; cognitive modulation of pain; coping; cost; diaries; disability; distraction; evidence base; experience; functional disability; functional outcomes; health care service utilization; health disparity; improved; innovation; mortality; multimodality; non-opioid analgesic; novel; online delivery; opioid epidemic; opioid therapy; pain perception; pain reduction; pain self-management; preference; programs; psychosocial; satisfaction; skills; social stigma; socioeconomic disparity; statistics; tool; virtual reality; virtual reality intervention; young adult

PROJECT SUMMARY/ABSTRACT. In adults with sickle cell disease (SCD), chronic pain is associated with substantial morbidity, mortality, and healthcare utilization. The incidence of chronic pain in SCD is high and is likely to increase as affected individuals transition through young adulthood. However, Black adults with SCD often encounter challenges in obtaining comprehensive care for chronic pain that includes behavioral pain management strategies. As a result, chronic pain is typically managed with opioids but opioids alone are often suboptimal, are associated with poor health outcomes, and their use is limited by access restrictions due to the current opioid epidemic in the United States. Therefore, alternative, evidence-based, non-pharmacological options are needed to address the psychosocial aspects of chronic pain and support pain self-management in the home setting in order to decrease the burden of SCD and improve the quality of life of affected individuals. Virtual reality (VR) is a timely and innovative tool that has resulted in pain reduction for individuals who experience chronic pain conditions, such as complex regional pain syndrome, fibromyalgia, and chronic migraines. While VR applications have typically been used in a clinic or hospital setting primarily for acute pain, cost reductions and advances in the technology have created the potential for its long-term use at home. In addition, the popularity of mobile and gaming technology among young adults suggests that VR is a promising delivery platform. Therefore, VR may be utilized to implement home-based chronic pain self-management for adults with SCD. To date, there have been no published studies of VR interventions for chronic pain management in the home setting for adults with SCD. This project will evaluate AppliedVR's EaseVRx – a multi-modal, skills-based, 8-week, VR, home intervention – in an exploratory trial for self-management of chronic pain among 60 Black, young adults (ages 18–40) with SCD. EaseVRx experiences are based on evidence-based pain management approaches related to pain education, pain psychology, biofeedback training, relaxation, and distraction. Similar to in-person integrative pain management programs, EaseVRx provides therapeutic information to support participants in learning cognitive and behavior self-management skills, and retraining the pain pathways. A single-site, mixed-methods, exploratory, parallel-group randomized controlled trial (RCT), of EaseVRx versus active control, among adults with SCD will be conducted to: 1) determine the feasibility of using EaseVRx for self-management of chronic pain; 2) assess the preliminary efficacy of EaseVRx on pain and pain-related outcomes; and 3) assess how EaseVRx can be tailored for a target audience that mostly consists of Black individuals. Data will be obtained from electronic medical records, validated surveys, a pain dairy, device usage statistics, and qualitative individual interviews or focus group sessions. This project aligns with the priorities of NINR. Study findings will be used to develop and test a tailored, home-based, pain self-management intervention for adults with SCD in a larger RCT.

项目摘要/摘要。在患有镰状细胞病 (SCD) 的成人中，慢性疼痛与 大量的发病率、死亡率和医疗保健利用率。 SCD 中慢性疼痛的发生率很高，并且 随着受影响的个体过渡到成年早期，这种情况可能会增加。然而，患有 SCD 的黑人成年人 在获得慢性疼痛（包括行为疼痛）的全面护理方面经常遇到挑战 管理策略。因此，慢性疼痛通常使用阿片类药物来治疗，但单独使用阿片类药物通常会导致慢性疼痛。 次优，与不良的健康结果相关，并且由于以下原因，它们的使用受到访问限制的限制 目前美国阿片类药物流行。因此，替代的、基于证据的、非药物的 需要选择解决慢性疼痛的社会心理问题并支持患者的疼痛自我管理 家庭环境，以减轻 SCD 的负担并提高受影响个人的生活质量。 虚拟现实 (VR) 是一种及时且创新的工具，可以减轻患有以下疾病的人的疼痛： 经历慢性疼痛，例如复杂区域疼痛综合征、纤维肌痛和慢性疼痛 偏头痛。虽然 VR 应用通常用于诊所或医院环境，主要用于治疗急性疼痛， 成本的降低和技术的进步创造了其在国内长期使用的潜力。在 此外，移动和游戏技术在年轻人中的流行表明 VR 是一种很有前途的技术 交付平台。因此，VR可用于实施家庭慢性疼痛自我管理。 患有 SCD 的成人。迄今为止，尚未发表关于 VR 干预慢性疼痛的研究 患有 SCD 的成人的家庭环境管理。该项目将评估 AppliedVR 的 EaseVRx – 多模式、基于技能、8周、虚拟现实、家庭干预——自我管理的探索性试验 60 名患有 SCD 的黑人年轻人（18-40 岁）患有慢性疼痛。 EaseVRx 体验基于 与疼痛教育、疼痛心理学、生物反馈相关的循证疼痛管理方法 训练、放松和分散注意力。与面对面的综合疼痛管理计划类似，EaseVRx 提供治疗信息以支持参与者学习认知和行为自我管理 技能，并重新训练疼痛通路。单中心、混合方法、探索性、平行组随机 在患有 SCD 的成人中进行 EaseVRx 与主动对照的对照试验 (RCT)，目的是：1) 确定使用 EaseVRx 自我​​管理慢性疼痛的可行性； 2) 初步评估 EaseVRx 对疼痛和疼痛相关结果的功效； 3) 评估如何针对 EaseVRx 进行定制 目标受众主要由黑人组成。数据将从电子病历中获取， 经过验证的调查、疼痛日记、设备使用统计数据以及定性个人访谈或焦点小组 会议。该项目符合 NINR 的优先事项。研究结果将用于开发和测试 在一项大型随机对照试验中，为患有 SCD 的成人量身定制、以家庭为基础的疼痛自我管理干预措施。