Telehealth CBT to increase engagement in pain treatment among Veterans using prescription opioids

远程医疗 CBT 可提高使用处方阿片类药物的退伍军人对疼痛治疗的参与度

• 批准号: 10665132
• 负责人: LISHAM ASHRAFIOUN
• 金额: --
• 依托单位: VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10665132
• 关键词: Address; Affect; African American; African American population; Aftercare; Area; Behavior; Belief; Caring; Cessation of life; Clinical Practice Guideline; Cognitive Therapy; Collaborations; Complementary Health; Data; Diabetes Mellitus; Disease; Disparity; Education; Evidence based intervention; Exercise Pain Management; Fentanyl; Goals; Growth; Health Food; Health Personnel; Health Services; Healthcare; Heart Diseases; Heroin; Housing; Incidence; Income; Individual; Inequity; Inferior; Integrative Medicine; Intervention; Investigation; Knowledge; Medical; Mental Health; Mental Health Services; Mentorship; Methodology; Minority Groups; Modality; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Participant; Patients; Plague; Policies; Population; Post-Traumatic Stress Disorders; Prevalence; Provider; Race; Randomized; Recommendation; Recording of previous events; Reporting; Research; Risk; Safety; Sampling; Scientist; Severities; Stress; Stroke; Techniques; Training; Treatment Efficacy; Veterans; alcohol use disorder; barrier to care; care systems; chronic pain; chronic pain management; disparity reduction; drug testing; efficacy evaluation; empowerment; evidence base; experience; health disparity; health service use; improved; mindfulness-based stress reduction; opioid epidemic; opioid misuse; opioid mortality; opioid tapering; opioid therapy; opioid use; opioid user; pain outcome; pain relief; patient oriented; patient population; prescription opioid; prevent; psychosocial; racial difference; racial discrimination; racial disparity; racism; randomized, clinical trials; responsible research conduct; social health determinants; substance use treatment; telehealth; unconscious bias

Background: There are striking disparities in the opioid crisis and growing evidence of racial disparities related to chronic pain prevalence, management, and pain outcomes (e.g., higher opioid oversdose deaths), especially for African American (AA) patients. Racism (e.g. race-related stress [RSS]) is a key social determinant of health negatively impacting assessment and treatment of pain, and treatment-seeking behaviors among AA. To reduce disparities, it is imperative to address treatment-seeking behaviors that can help facilitate engagement in treatment for pain among AA in culturally sensitive way. Clinical Practice Guidelines for opioid prescribing and pain management recommend using non-pharmacological approaches as first-line treatments. Psychosocial interventions (e.g., cognitive-behavioral therapy) have strong evidence supporting their ability to improve pain outcomes. Inherent to the CBT approach are culturally-sensitive techniques (e.g., individualism, non-judgement, collaboration, empowerment) that are particularly advantageous when working with AA. Significance/Impact: Without a concerted effort to attend to AA group specific-needs–in a culturally-sensitive way that can affect beliefs that impede engagement in treatment–AA Veterans who may benefit from the treatment, will not receive it. This can result in continued risk for negative consequences associated with long- term opioid therapy and a perpepuation of racial disparities. Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS) is an evidence-based intervention that directly intervenes on beliefs that act as barriers to treatment initiation and retention. As a CBT approach, CBT-TS lends itself well to working with culturally diverse patients, particularly AA patients. By intervening on these beliefs, in a culturally-sensitive way, this study has the potential to improve engagement in psychosocial pain interventions and other non-pharmacological pain treatments, which will improve pain-related outcomes and increase treatment engagement among AA. This study addresses VHA/VA Veteran care priorities including opioid use, pain management, and access and directly addresses priorities of the HSR&D Targeted Solicitation for Resarch Supplements to Promote Diversity. Specific Aims: The primary objective of the proposed project is to examine the efficacy of, and mechanisms of action in CBT-TS to identify factors that facilitate the initiation of psychosocial pain treatment among AAV using opioid analgesics for chronic pain. The specific aims are to: examine treatment efficacy (treatment initiation) for CBT-TS among AAV receiving opioid analgesics for chronic pain (Aim 1); identify mechanisms of action in CBT- TS that increase treatment initiation among AAV receiving opioid analgesics for chronic pain (Aim 2); examine the effects of racism (experiences of racial discrimination, race-related stress) on treatment initiation, retention and completion for AAV who receive psychosocial treatment for chronic pain management (Exploratory). Methodology: Participants (N = 300) will be randomized to either the CBT-TS condition or an education control condition. Approximately 25% (N = 76) of this sample will be AA and used in analyses. AAarticipants in both conditions will complete assessments on pain, treatment engagement (including questions specific to culturally sensitve mechanicsms), race-related stress and opioid use at baseline, and 1-, 3-, and 6-months post-treatment to assess primary, secondary, and exploratory outcomes. Next Steps: Results from this study will provide critical information on increasing engagement of AA psychosocial interventions for pain and provide data on the impact of race-related stress on treatment seeking behaviors and engagement. This study will provide critical pilot data on mechanisms of action that are particulary salient for AA treatment engagment. This study is the first-step toward developing a more culturally sensitive approach to treatment of chronic pain for AA Veterans. Next steps involve a trial utilizing data from this project to prepare an application to evaluate the feasibility, acceptability, and safety of a modified version of CBT-TS and later a larger randomized clinical trial to examine the efficacy of the adapted treatment.

背景：阿片类药物危机存在显着差异，并且越来越多的证据表明与阿片类药物危机相关的种族差异 慢性疼痛的患病率、治疗和疼痛结果（例如阿片类药物过量死亡较高），尤其是 对于非裔美国人 (AA) 患者。种族主义（例如与种族相关的压力 [RSS]）是健康的关键社会决定因素 对 AA 中疼痛的评估和治疗以及寻求治疗行为产生负面影响。减少 差异，必须解决有助于促进参与的寻求治疗行为 以文化敏感的方式治疗 AA 中的疼痛。阿片类药物处方和临床实践指南 疼痛管理建议使用非药物方法作为一线治疗。社会心理 干预措施（例如认知行为疗法）有强有力的证据支持其改善疼痛的能力 结果。 CBT 方法固有的是文化敏感技术（例如个人主义、不评判、 与 AA 合作时特别有利。 意义/影响：在文化敏感的情况下，如果没有共同努力满足 AA 群体的具体需求 可能影响阻碍参与治疗的信念的方式——可能受益于治疗的 AA 退伍军人 治疗，不会接受它。这可能会导致与长期相关的负面后果持续存在风险。 术语阿片类药物疗法和种族差异的延续。用于寻求治疗的认知行为疗法 (CBT-TS) 是一种基于证据的干预措施，直接干预阻碍治疗的信念 启动和保留。作为一种 CBT 方法，CBT-TS 非常适合与不同文化的患者合作， 尤其是AA患者。通过以文化敏感的方式干预这些信念，这项研究有潜力 提高社会心理疼痛干预和其他非药物疼痛治疗的参与度， 这将改善疼痛相关的结果并增加 AA 的治疗参与度。本研究解决 VHA/VA 退伍军人护理优先事项包括阿片类药物的使用、疼痛管理以及获取和直接解决 HSR&D 有针对性地征集研究补充材料以促进多样性的优先事项。 具体目标：拟议项目的主要目标是检查以下措施的功效和机制： CBT-TS 中的行动，以确定促进 AAV 使用的心理社会疼痛治疗开始的因素 用于治疗慢性疼痛的阿片类镇痛药。具体目标是： 检查治疗效果（治疗开始） 接受阿片类镇痛药治疗慢性疼痛的 AAV 中的 CBT-TS（目标 1）；确定 CBT 的作用机制 TS 增加接受阿片类镇痛药治疗慢性疼痛的 AAV 的治疗起始时间（目标 2）；检查 种族主义（种族歧视经历、种族相关压力）对治疗开始、保留的影响 接受慢性疼痛管理心理社会治疗的 AAV 和完成（探索性）。 方法：参与者 (N = 300) 将被随机分配到 CBT-TS 条件或教育对照 健康）状况。该样本中大约 25% (N = 76) 将是 AA 并用于分析。 AA 双方参与者 条件将完成对疼痛、治疗参与度的评估（包括特定于文化的问题） 敏感机制）、基线时以及治疗后 1、3 和 6 个月时与种族相关的压力和阿片类药物的使用 评估主要、次要和探索性结果。 后续步骤：这项研究的结果将为提高 AA 参与度提供重要信息 针对疼痛的心理社会干预措施，并提供有关种族相关压力对寻求治疗的影响的数据 行为和参与度。这项研究将提供有关作用机制的关键试点数据，特别是 对于 AA 治疗参与而言非常重要。这项研究是发展更具文化敏感性的第一步 AA 退伍军人慢性疼痛的治疗方法。下一步涉及利用该项目的数据进行试验 准备一份申请来评估 CBT-TS 修改版本的可行性、可接受性和安全性 随后又进行了一项更大规模的随机临床试验，以检验调整后的治疗方法的疗效。