Optimizing Response to Chronic Pain Treatments in Veterans: Identifying Key Moderators

项目摘要 慢性疼痛是一个普遍存在的致残问题，影响着多达50%的男性和75%的女性退伍军人。 人们普遍认识到发展有效、互补和综合的重要性 健康(CIH)治疗以及优化其有效性的必要性。世界上治疗CIH疼痛最多的 经验支持是认知行为疗法(CBT)。然而，并不是每个人都能从CBT中受益。之前 研究表明，两种CIH干预措施，基于正念的认知疗法(MBCT)和催眠药 认知疗法(HYP-CT)是有益的，提供了CBT的替代方案，具有类似的疗效。然而， 与CBT一样，个体对这些治疗的反应也有很大差异。我们的初步数据显示 治疗结果的差异可能是由于重要的基线患者差异所致。这表明 患者可以有效地与他们最有可能受益的治疗相匹配的可能性， 根据治疗开始前可以获得的信息。需要研究来发展患者- 最有可能将给定个体与循证治疗相匹配的治疗匹配算法 考虑到他们独特的个人特征，这是有益的。拟议研究的总体目标就是解决这个问题。 通过确定决定谁从两种CIH治疗中受益最大的患者因素和当前 黄金标准的非药物治疗(CBT)，相对于通常的护理。这一目标将通过使用 临床试验，参与者将被随机分配到四种治疗条件中的一种。我们将测试 从理论和先前的先导研究中发展而来的假设--治疗前的大脑活动模式， 催眠性、灾害性和正念对治疗前后疼痛的改善是适度的 退伍军人的CBT、MBCT和HYP-CT与常规护理相关的强度 慢性疼痛。这些发现将为建立支持个性化护理的算法提供基础， 从而为退伍军人提供对他们最有益的治疗。这项研究也将有所帮助 发展关于药理/阿片类止痛方法的潜在有效替代品的知识。 最后，研究结果将对医疗保健提供者及其患者有用，以促进共同决策- 制作。

Project Summary Chronic pain is a prevalent, disabling problem affecting as many as 50% of men and 75% of women Veterans. There is widespread recognition of the importance of developing effective complementary and integrative health (CIH) treatments and the need to optimize their effectiveness. The CIH pain treatment with the most empirical support is cognitive-behavioral therapy (CBT). However, not everyone benefits from CBT. Prior research has shown that two CIH interventions, Mindfulness-Based Cognitive Therapy (MBCT) and Hypnotic Cognitive Therapy (HYP-CT), are beneficial and offer alternatives to CBT and have similar efficacy. However, as with CBT, individual response to these treatments also varies considerably. Our preliminary data suggests the variability in treatment outcome may be due to important baseline patient differences. This suggests the possibility that patients can be effectively “matched” to the treatments they are most likely to benefit from, based on information that can be obtained before treatment starts. Research is needed to develop patient- treatment matching algorithms that could match a given individual to the evidence-based treatment most likely to be beneficial given their unique individual profile. The overall aim of the proposed study is to address this need by identifying patient factors that determine who benefits most from two CIH treatments and the current gold standard non-pharmacological treatment (CBT), relative to usual care. This aim will be addressed using a clinical trial in which participants will be randomized to one of the four treatment conditions. We will test hypotheses – developed from both theory and prior pilot research – that pre-treatment brain activity patterns, hypnotizability, catastrophizing, and mindfulness moderate pre- to post-treatment improvements in pain intensity associated with group-delivered CBT, MBCT, and HYP-CT, relative to usual care, in Veterans with chronic pain. The findings will provide the foundation for building an algorithm to support personalized care, whereby Veterans can be offered the treatment that will be most beneficial for them. This study will also help develop knowledge about potentially powerful alternatives to pharmacological/opioid analgesic approaches. Finally, the study findings will be useful to health care providers and their patients to facilitate shared decision- making.