Chronic pain self-management for older adults with cognitive impairment: A randomized pilot trial

项目摘要 针对慢性疼痛的心理社会干预措施在日益增长的老年人口群体中基本上没有得到检验。 患有轻度认知障碍或早期阿尔茨海默病及相关痴呆(MCI/ADRD)。 慢性疼痛和认知障碍都会加剧对方的症状，加速功能衰退。 虽然认知行为策略可以改善疼痛相关的功能，但标准的干预教学 这些技能对有认知缺陷的老年人可能无效。这项拟议的补充意见将增强 父母研究的工作，一项关于STEPS慢性疼痛自我管理的随机对照试验 对服务不足的老年人进行干预，修改干预措施，使其适用于与 MCI/ADRD。最初的步骤是通过与社区卫生工作者的电话会议进行的，是 已经旨在解决低收入城市社区普遍存在的挑战，如健康素养低， 资源需求，缺乏交通工具。名为STEPS-CI的新版本将提供简化的慢性疼痛 教育和经修改的技能建设程序，并将把参与者与MCI/ADRD的资源联系起来 以及照顾他人。本增刊的准备工作包括：1)采访有关疼痛的专家 MCI/ADRD患者的管理能力和需求；以及2)与MCI/ADRD患者一起生活的焦点小组 慢性疼痛和MCI/ADRD。研究结果证实，在这方面需要改进疼痛管理技能 并提供了有关如何量身定做步骤的信息。本补充资料的目的如下 1)根据初步调查结果，并与新成立的STEPS协商--CI咨询 理事会，修改现有的STEPS课程和计划材料；以及2)进行NIH行为 干预阶段1随机试点试验，对象为50名报告慢性疾病的老年人(有可选的护理伙伴) 肌肉骨骼疼痛和轻中度认知障碍，并评估其可接受性和初步 对原发(疼痛干预)和继发(疼痛强度和主观认知功能)的影响 结果。对止痛药使用的影响将是一个探索性的结果。将使用混合方法来 评估关键计划流程，包括参与者参与度，并阐明观察到的原因 结果。试点研究参与者将从与家长试验相同的城市社区招募(底特律， MI)，利用现有机制；作为一项探索性要素，北部农村参与者的一部分 考虑到这两个服务不足的地区在准入障碍方面的相似之处，密歇根州也将被招募 人口。由人们领导的倡导和支持组织--全国痴呆症精神理事会 痴呆症患者，将通过STEPS-CI咨询委员会就所有研究阶段和过程提供建议。 如果STEPS-CI被证明是可行的，该试点研究为随后的阶段2或3试验奠定了基础 展示潜在的功效；否则，它将提供有价值的信息，有助于开发 满足患有MCI/ADRD的老年人慢性疼痛管理需求的替代方法。

Project Summary Psychosocial interventions for chronic pain are largely untested in the growing segment of the older population living with mild cognitive impairment or early-stage Alzheimer’s disease and related dementias (MCI/ADRD). Chronic pain and cognitive impairment each exacerbate symptoms of the other, accelerating functional decline. While cognitive-behavioral strategies can improve pain-related functioning, standard interventions teaching these skills may not be effective in older adults with cognitive deficits. This proposed supplement will augment the work of the parent study, a randomized controlled trial of the STEPS chronic pain self-management intervention for underserved older adults, by modifying the intervention to be suitable for people living with MCI/ADRD. The original STEPS, delivered through telephone sessions with a community health worker, is already designed to address challenges common in low-income urban communities such as low health literacy, resource needs, and lack of transportation. The new version, called STEPS-CI, will offer simplified chronic pain education and modified processes for skill-building, and will connect participants to resources for MCI/ADRD and caregiving. Preparatory work for this supplement included: 1) interviews with experts about the pain management capabilities and needs of people with MCI/ADRD; and 2) focus groups with people living with chronic pain and MCI/ADRD. Findings confirmed the need for improved pain management skills in this population and yielded information about how STEPS could be tailored. The aims of this supplement are as follows: 1) Based on preliminary findings and in consultation with the newly formed STEPS-CI Advisory Council, modify the existing STEPS curriculum and program materials; and 2) Conduct a NIH Behavioral Intervention Stage 1 randomized pilot trial with 50 older adults (with optional care partners) who report chronic musculoskeletal pain and mild to moderate cognitive impairment, and assess its acceptability and preliminary effects on primary (pain interference) and secondary (pain intensity and subjective cognitive function) outcomes. Impact on pain medication use will be an exploratory outcome. Mixed methods will be used to evaluate key program processes including participant engagement, and to shed light on reasons for observed outcomes. Pilot study participants will be recruited from the same urban community as the parent trial (Detroit, MI), leveraging existing mechanisms; and, as an exploratory element, a subset of rural participants in northern Michigan will also be recruited, given the similarities in access barriers across these two underserved populations. The National Council of Dementia Minds, an advocacy and support organization led by people living with dementia, will advise on all study phases and processes through the STEPS-CI Advisory Council. This pilot study set the stage for a subsequent Stage 2 or 3 trial, if STEPS-CI is shown to be feasible and demonstrates potential efficacy; otherwise, it will provide valuable information leading to the development of alternative ways to meet the chronic pain management needs of older adults living with MCI/ADRD.