Brief Cognitive Behavioral Therapy for Chronic Pain to Improve Functional Outcomes amongPrimary Care Veterans

国家指南，如疾病控制中心的指南，推荐心理治疗

National guidelines, such as those from the Centers for Disease Control, recommend psychological therapies over opioid therapy as a preferred first line treatment for chronic pain. Behavioral health providers embedded in primary care as part of the VA’s national Primary Care-Mental Health Integration (PCMHI) program are well- positioned to support Veterans with pain by delivering treatments to improve functional recovery. Cognitive behavioral therapy for chronic pain is widely recognized as a safe and effective psychological treatment. However, this treatment is typically a lengthy psychotherapy (≥10, 50-minute sessions) designed for specialized care settings. In contrast, PCMHI services are brief and time-limited (≤6, 30-minute sessions) to be consistent with primary care services that treat a high volume of patients. To extend the reach of treatment to primary care Veterans who present with a pain concern, we have developed a PCMHI-based version titled Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP). Brief CBT-CP condenses content into only six sessions organized around the 30-minute appointment structure used by PCMHI providers. Brief CBT- CP was recently evaluated in a clinical demonstration project that found a statistically and clinically significant decrease in a composite measure of pain intensity and pain-related activity interreference following treatment. On average, the majority of improvement was achieved in the first three sessions of treatment signaling that Brief CBT-CP can potentially produce rapid clinical benefit. Our funded RR&D SPiRE (in progress) indicates the high feasibility of our trial methods as we frequently exceeded planned monthly recruitment goals with high retention. Additionally, patients have reported high levels of treatment satisfaction and PCMHI providers report that Brief CBT-CP is an important and feasible intervention. Based on these preliminary studies, this application proposes to conduct a single-blind, double-arm, randomized controlled trial among [178] Veterans with chronic musculoskeletal pain and pain-related functional impairment who receive primary care services at the VA Western New York Healthcare System. Veterans will be randomized to either (1) Brief CBT-CP and primary care treatment as usual (TAU) or (2) TAU only. Patient data will be collected at baseline, mid-treatment (6-week), post-treatment (12-week), and follow-up (6-month) to evaluate through multilevel modeling if Brief CBT-CP produces a rapid decrease in pain-related activity interference (primary outcome). Secondary clinical outcomes (pain intensity, depression symptoms, suicidal ideation, quality of life, and social role engagement) will be assessed in the same manner. The second goal of the study is to assess potential treatment mediators (i.e., pain self-efficacy and catastrophizing) and moderators (i.e., demographic factors, treatment expectations, opioid and adjunctive treatment use, therapeutic alliance) to determine if these factors impact outcomes. The third aim of the study incorporates a mixed methods component by including qualitative interviews with patients to illuminate how Brief CBT-CP contributes to improvement in functional status and improved life role engagement. This study is well-aligned with the mission of RR&D and supports the VA clinical goals nationally by promoting a safe, accessible, non-pharmacological treatment for chronic pain early in the trajectory of care.