Health Coaching for Chronic Multi-symptom Illness

慢性疼痛是我们社会面临的最广泛的医疗保健问题之一，对所有人都有严重影响 它的受害者生活的方方面面。以疼痛为主的慢性多症状疾病(疼痛-CMI，例如， 纤维肌痛)是一种特别虚弱和对治疗有抵抗力的慢性疼痛状况， 1990-2021年期间部署到海湾地区的退伍军人的服务连接条件。退伍军人事务部/国防部 指南建议对疼痛进行非药物治疗(如认知行为疗法)-CMI和 找到证据表明，它们(通常)通过靶向疼痛-CMI(例如，低)的机制来改善残疾 感觉到的疼痛控制、灾难和限制活动)。虽然没有单一的治疗方法是(或很可能是) 所有退伍军人都可以接受、可用和有效，拥有广泛的治疗选择有助于 退伍军人对非药物方法的接受。健康指导是一种有吸引力的潜在方法 改善疼痛-CMI的残疾，因为它具有很高的可接受性，并将像VA一样广泛使用 针对其他情况推出健康指导(高可用性)。这项提案的目标是了解如果 健康指导对复杂的疼痛状况也是有效的，疼痛-CMI。健康教练有很高的 可接受性，因为它解决了专家、临床医生和患者一致认为的低满意度和 依从性--患者和医疗服务提供者之间关于致病原因和最佳治疗方法的分歧 疼痛-CMI。在健康指导中，健康教练引出退伍军人的信念，并利用这些信念来发展一种共享的 对疼痛的理解-CMI。然后，健康教练确定退伍军人在生活中的不同之处 以及这位老兵想去的地方。激励性访谈、目标设定和解决问题的方法 帮助退伍军人减少这些差异。目前提案的目标是进行随机化 确定远程健康指导对减少残疾和疼痛的有效性的临床试验 退伍军人疼痛-CMI损害与支持性心理治疗的比较(n=250)，并探讨 改变的机制。退伍军人管理局已经推出了针对其他疾病的全面健康指导方法。 因此，如果被发现是有效的，我们的健康教练干预可以教给退伍军人健康教练 全国范围内的供应商。这将增加对患有疼痛-CMI的退伍军人的护理机会。退伍军人事务部，28岁 国会授权它在CMI方面提供领导和专业知识，它正在密切关注我们的努力 指导他们的决定和潜在的国家实施疼痛-CMI的健康指导。有一个 迫切需要经验数据来指导这些决定。

Chronic pain is one of the most extensive health care issues facing our society with “severe impacts on all aspects of the lives of its sufferers.” Pain predominant chronic multisymptom illness (Pain-CMI, e.g., fibromyalgia) is a particularly debilitating and treatment resistant chronic pain condition and a presumptive service connected condition for Veterans who deployed to the Gulf region from 1990-2021. The VA/DoD Guidelines recommend non-pharmaceutical treatments (e.g., cognitive behavioral therapy) for Pain-CMI and find evidence they improve disability (typically) by targeting the mechanisms underlying Pain-CMI (e.g., low perceived pain control, catastrophizing and limiting activity). While no single treatment is (or is likely to be) acceptable, available and efficacious for all Veterans, having a wide array of treatment options facilitates Veterans’ uptake of non-pharmaceutical approaches. Health coaching is an appealing potential approach to improve the disability of Pain-CMI because it has high acceptability and it will be widely available as the VA is rolling out health coaching for other conditions (high availability). The goal of this proposal is to understand if health coaching is also efficacious for complex pain condition, Pain-CMI. Health coaching has high acceptability because it addresses what experts, clinicians and patients agree is a driver of low satisfaction and adherence - disagreement between the patient and providers about the cause of and best approaches for Pain-CMI. In health coaching, the health coach elicits the Veteran’s beliefs and uses these to develop a shared understanding of Pain-CMI. The health coach then identifies discrepancies between where in life the Veteran is and where the Veteran wants to be. Motivational interviewing, goal setting and problem-solving are used to help the Veteran reduce these discrepancies. The goal of the current proposal is to conduct a randomized clinical trial to determine the efficacy of remote-delivered health coaching to reduce the disability and pain impairment for Veterans with Pain-CMI as compared to supportive psychotherapy (n=250), and to explore mechanisms of change. The VA has already rolled out whole health coaching approaches for other conditions. Thus, if found to be efficacious, our health coaching intervention can be taught to VA whole health coaches and providers nationally. This would increase access to care for Veterans with Pain-CMI. The VA WRIISC,28 which is mandated by Congress to provide leadership and expertise in CMI, is closely following our efforts to guide their decisions and potential national implementation of health coaching for Pain-CMI. There is a desperate need for empirical data to guide these decisions.