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，越来越多的证据表明种族差异与阿片类药物危机有关。 慢性疼痛的患病率、管理和疼痛结果（例如，阿片类药物过量死亡率较高），特别是 非裔美国人（AA）种族主义（如种族相关压力[RSS]）是健康的一个关键社会决定因素 对疼痛的评估和治疗以及AA患者的寻求治疗行为产生负面影响。减少 差异，必须解决寻求治疗的行为，这有助于促进参与 以文化敏感的方式治疗AA中的疼痛。阿片类药物处方临床实践指南 疼痛管理建议使用非药物方法作为一线治疗。心理社会 干预（例如，认知行为疗法）有强有力的证据支持他们改善疼痛的能力 结果。CBT方法固有的是文化敏感的技术（例如，个人主义，不加评判， 合作，授权），这是特别有利的，当与AA。 意义/影响：没有共同努力以文化敏感的方式满足AA群体的特殊需求 方式，可以影响信念，阻碍参与治疗-AA退伍军人谁可能受益于 这可能会导致与长期- 长期阿片类药物治疗和种族不平等的延续。治疗寻求的认知行为疗法 （CBT-TS）是一种循证干预，直接干预作为治疗障碍的信念 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，这项研究有可能 为了改善心理社会疼痛干预和其他非药物疼痛治疗的参与， 这将改善疼痛相关的结果，并增加AA的治疗参与。这项研究涉及 VHA/VA退伍军人护理优先事项，包括阿片类药物的使用，疼痛管理和访问，并直接解决 HSR&D有针对性地征求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研究 在CBT-TS中采取行动，确定促进使用AV开始心理社会疼痛治疗的因素 阿片类镇痛药治疗慢性疼痛具体目标是：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（目的1）;确定CBT- TS在接受阿片类镇痛药治疗慢性疼痛的AAV中增加治疗开始（目的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 和完成的AAV谁接受心理社会治疗慢性疼痛管理（探索性）。 方法：参与者（N = 300）将被随机分配到CBT-TS条件或教育对照组 条件该样本中约25%（N = 76）将为AA并用于分析。A两种情况都有 条件将完成对疼痛，治疗参与（包括特定于文化的问题） 在基线和治疗后1个月、3个月和6个月， 评估主要、次要和探索性结局。 下一步：本研究的结果将提供有关增加AA参与的关键信息 疼痛的心理社会干预，并提供种族相关压力对寻求治疗的影响的数据 行为和参与。这项研究将提供关键的试点数据的作用机制，特别是 对AA治疗的重要性。这项研究是发展一种更具有文化敏感性的 方法来治疗慢性疼痛的AA退伍军人。接下来的步骤包括利用该项目的数据进行试验 准备一份申请，以评估CBT-TS改良版的可行性、可接受性和安全性 随后进行更大规模的随机临床试验，以检验适应性治疗的疗效。