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

项目摘要 慢性疼痛是一种普遍的致残性问题，影响多达50%的男性和75%的女性退伍军人。 人们普遍认识到发展有效的互补性和综合性的 健康（CIH）治疗和需要优化其有效性。CIH疼痛治疗最 实证支持是认知行为疗法（CBT）。然而，并非所有人都能从CBT中受益。之前 研究表明，两种CIH干预，正念认知疗法（MBCT）和催眠， 认知疗法（HYP-CT）是有益的，提供了CBT的替代方案，并具有相似的疗效。然而，在这方面， 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 治疗结果的可变性可能是由于重要的基线患者差异。这表明 患者可以有效地“匹配”他们最有可能受益的治疗的可能性， 基于在治疗开始之前可以获得的信息。需要研究来开发患者- 治疗匹配算法，可以将给定个体与最有可能的循证治疗相匹配 是有益的，因为他们独特的个人资料。拟议研究的总体目标是解决这一问题 通过确定患者因素，确定谁从两种CIH治疗中获益最多， 金标准非药物治疗（CBT），相对于常规护理。这一目标将通过一个 参与者将被随机分配到四种治疗条件之一的临床试验。我们将测试 假设-从理论和先前的试点研究发展-治疗前的大脑活动模式， 催眠、灾难化和正念调节治疗前后疼痛的改善 与常规护理相比，在患有糖尿病的退伍军人中， 慢性疼痛这些发现将为构建支持个性化护理的算法提供基础， 这样退伍军人就可以得到对他们最有利的治疗。这项研究也将有助于 发展关于药理学/阿片类镇痛方法的潜在强大替代方法的知识。 最后，研究结果将有助于卫生保健提供者和他们的病人，以促进共同的决定， 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.