Efficacy of Mind-Body Approaches for the Treatment of Chronic Pain with Psychological Comorbidity

慢性疼痛(CP)，定义为持续性(6个月)、非恶性、肌肉骨骼或全身性 疼痛，是一个普遍且代价高昂的公共卫生问题。CP在退伍军人中非常普遍；30%-40% 退伍军人有中到重度的脑瘫。CP对心理健康和生活质量有显著的负面影响 生活。脑性瘫痪与身体和社交功能下降、活动水平降低、焦虑、 消极的情绪和抑郁。约160万退伍军人健康管理局(VHA)登记 退伍军人患有脑瘫和与心理健康并存相关的心理困扰，包括 创伤后应激障碍(PTSD；~50%)、抑郁症(~25%)和焦虑症(S)(~25%)。尽管如此 迫切的临床需求和巨大的经济和社会代价，目前还没有证据支持 同时针对共病心理健康症状和CP干预的心理社会干预 退伍军人。 建议的CDA-2将包括一项随机对照试验(RCT)，以评估 慢性疼痛伴心理共病的认知同情训练(CBCT-CP+)这个 试验将比较CBCT-CP+与痛苦生活中的健康教育(H.E.L.P.)控制条件，在 弗吉尼亚州圣地亚哥医疗中心126名患有脑瘫和心理合并症的退伍军人样本 系统(VASDHS)。对慢性阻塞性肺病患者进行同情冥想研究的理论基础 合并症的诱因是(1)迫切的临床需要，(2)明确的理论模型，以及(3) 它对改善退伍军人精神状况的安全性、可行性和潜在的积极临床效果。 这项研究与退伍军人管理局的多个利益相关者直接相关(即，调查 治疗复杂身心健康的互补和综合健康方法 问题)。拟议的随机对照试验的结果将通过调查一项 针对CP和心理并存的基于同情心的干预将改善治疗 退伍军人的结果。 拟议的CDA-2将为我提供一个重要的培训机会，使我的 研究兴趣和专长领域(慢性疼痛和相关心理健康的社会心理干预 条件和补充和综合保健方法，包括冥想)。我将由以下人员指导 擅长CP治疗和评估、RCT设计和实施的顶尖专家， 补充和综合保健方法，特别是冥想，以冥想为基础的机制 止痛药和生物统计学。拟议的工作将在一个领先的退伍军人研究中心内进行 (VASDHS)和世界著名的研究机构(UCSD医学院)。 拟议的审判还将使我能够获得必要的培训，以实现我的长期 目标是成为退伍军人事务部的一名独立研究员。RCT中的支架式培训和指导 设计和执行以及生物统计、补充和综合保健办法方面的高级培训， 职业发展将有助于推动我成为一名VA干预研究科学家的独立。 最后，试验结果将为试图确定疗效的多点研究奠定基础 CBCT-CP+在VA临床中的应用，并正式调查治疗效果的可能机制。这部作品 最终可以为退伍军人提供更好的护理，提高患者和治疗师的满意度，并降低 弗吉尼亚州

Chronic pain (CP), defined as persistent (>6 months), non-malignant, musculoskeletal or generalized pain, is a prevalent and costly public health problem. CP is highly prevalent among Veterans; 30-40% of Veterans have moderate to severe CP. CP has a significant negative impact on mental health and quality of life. CP is associated with declines in physical and social functioning, decreased activity levels, anxiety, negative mood, and depression. Approximately 1.6 million Veterans Health Administration (VHA) enrolled Veterans have CP and psychological distress associated with mental health comorbidities, including posttraumatic stress disorder (PTSD; ~50%), depression (~25%), and anxiety disorder(s) (~25%). Despite this urgent clinical need and extraordinary economic and societal costs, there are currently no evidence-based psychosocial interventions that simultaneously target comorbid mental health symptoms and CP interference in Veterans. The proposed CDA-2 will include a randomized controlled trial (RCT) to evaluate the efficacy of Cognitively-Based Compassion Training for Chronic Pain with Psychological Comorbidity (CBCT-CP+). The trial will compare CBCT-CP+ to Health Education while Living with Pain (H.E.L.P.) control condition, in a sample of 126 Veterans with CP conditions and psychological comorbidities at the VA San Diego Healthcare System (VASDHS). The rationale for the proposed study of compassion meditation for CP with psychological comorbidity is motivated by (1) a pressing clinical need, (2) a clear theoretical model, and (3) initial evidence of its safety, feasibility and potential positive clinical effect for improving psychiatric conditions among Veterans. This research is of direct relevance to multiple VA stakeholders (i.e., investigating the efficacy of complementary and integrative health approaches for the treatment of complex physical and mental health problems). Findings from the proposed RCT will inform clinical practice and policy by investigating whether a compassion-based intervention targeting both CP and psychological comorbidities will improve treatment outcomes for Veterans. The proposed CDA-2 will provide me with an important training opportunity to merge my primary research interests and areas of expertise (psychosocial interventions for chronic pain and related mental health conditions and complementary and integrative health approaches, including meditation). I will be mentored by leading experts who specialize in CP treatment and assessment, RCT design and implementation, complementary and integrative health approaches, particularly meditation, mechanisms of meditation-based pain relief, and biostatistics. The proposed work will be conducted within a leading VA research center (VASDHS) and world-renowned research institution (UCSD School of Medicine). The proposed trial will also allow me to obtain the necessary training for achievement of my long-term goal to become an independent researcher within VA. Scaffolded training and mentorship in RCT design and execution and biostatistics, advanced training in complementary and integrative health approaches, and professional development will help propel me to independence as a VA intervention research scientist. Finally, results of the trial will lay the groundwork for multi-site studies that would attempt to determine efficacy of CBCT-CP+ across VA clinics and formally investigate putative mechanisms of treatment effects. This work could ultimately lead to better care for Veterans, greater patient and therapist satisfaction, and lower costs to VA.