Development of the Pain Self-Management Program

描述(由申请人提供)：疼痛占每年就诊医生的近80%(国家卫生统计中心，1986；Stucky，Gold，&Zhang，2001；Winterowd，Beck，&Greuner，2003)，是残疾的主要来源，每年导致超过7亿个工作日的损失和1000亿美元的医疗费用(疼痛评估委员会报告，1986)。除了身体发病率和费用问题外，心理症状和生活质量下降也是慢性疼痛的常见伴随因素(Dworkin，Nagako，Hetzel，&Farrar，2001；McBeth，Macfarlane，&Silman，2002)。由于不同的调查得出了从7%(Bowsher，Rigge，&Sopp，1991)到40%(Brattberg，Thorslund，&Wikman，1989)的估计，因此无法获得临床疼痛障碍的确切患病率数据。根据疼痛类型的不同，对腰痛的估计从8%到45%不等(Girolamo，1991)，对于头痛的估计从2%到50%(Stewart，Shechter，&Rasmussen，1994)，甚至根据疼痛的定义，也从3%到37%不等(例如，Von Korff，Deworkin，&Le Resche，1990)。然而，保守估计，美国有大约8000万人患有挥之不去的疼痛问题(国家研究委员会，2001；美国人口普查局，1996)。尽管这一公共卫生问题非常严重，但由于医疗成本上升、需求增加以及多学科疼痛计划的可获得性减少，许多慢性疼痛患者发现很难获得治疗。因此，对替代护理形式的需求很大。拟议项目的目标是开发一种这样的替代方案，疼痛自我管理计划(PSMP)，这是一个为患有慢性疼痛的成年人提供的基于网络的心理教育自助系统。该计划基于基本的认知-行为原则，这些原则已有效地应用于临床实践、团体干预和自助书籍。第二阶段的目标是PSMP的最终开发和有效性测试，它将包括七个模块，包括计划概述、了解慢性疼痛、慢性疼痛自我评估概况、结果和建议，以及四个自我管理模块。此外，还将提供一些互动工具，供各自我管理模块使用。第二阶段的具体任务包括最后内容的开发和几个专家组的审查以及软件开发。在最终的Beta测试和修订之后，将在一项纵向研究中检验PSMP的有效性。在美国，大约有8000万人患有慢性疼痛。由于医疗保健成本高，服务需求增加，获得多学科治疗方案的机会越来越少，对替代的、成本效益高的干预措施的需求很大。拟议项目的目的是开发一种这样的替代方案，即疼痛自我管理计划(PSMP)，这是一个为患有慢性疼痛的成年人提供的基于网络的心理教育自助系统。该计划基于基本的认知-行为原则，这些原则已有效地应用于临床实践、团体干预和自助书籍。PSMP有可能以低成本向大量慢性疼痛患者提供科学合理的信息。

DESCRIPTION (provided by applicant): Pain accounts for almost 80% of all of the office visits to physicians each year (National Center for Health Statistics, 1986; Stucky, Gold, & Zhang, 2001; Winterowd, Beck, & Greuner, 2003) and is a major source of disability, accounting for upwards of 700 million lost work days and $100 billion in health care costs per year (Report of the Commission on Evaluation of Pain, 1986). In addition to physical morbidity and cost issues, psychological symptoms and lowered quality of life are frequent concomitants of chronic pain (Dworkin, Nagasako, Hetzel, & Farrar, 2001; McBeth, Macfarlane, & Silman, 2002). Precise prevalence figures for clinical pain disorders are not available, as different surveys have yielded estimates varying from 7% (Bowsher, Rigge, & Sopp, 1991) to 40% (Brattberg, Thorslund, & Wikman, 1989). Estimates vary by type of pain, ranging from 8% to 45% for low back pain (Girolamo, 1991) and from 2% to 50% for headaches (Stewart, Shechter, & Rasmussen, 1994) and differ even according to the definition of pain, ranging from 3% to 37% (e.g., Von Korff, Deworkin, & Le Resche, 1990). However, a conservative estimate would place the number of Americans with a lingering pain problem at approximately 80 million (National Research Council, 2001; U.S. Bureau of the Census, 1996). Despite the enormity of this public health problem, many individuals with chronic pain find it difficult to obtain treatment due to rising health care costs, increasing demand, and a reduction in the availability of multidisciplinary pain programs. Thus, there is a great need for alternative forms of care. The goal of the proposed project is the development of one such alternative, the Pain Self- Management Program (PSMP), a web-based psychoeducational self-help system for adults with chronic pain. The program is based on fundamental cognitive-behavioral principles that have been effectively applied in clinical practice, group interventions, and self-help books. The goal of Phase II is the final development and efficacy testing of the PSMP, which will consist of seven modules, including Program Overview, Understanding Chronic Pain, Profile of Chronic Pain Self-Assessment, Results, and Recommendations, and four Self-Management Modules. In addition, a number of interactive tools will be available for use across the Self-Management Modules. Specific Phase II tasks include final content development and review by several expert groups and software development. Following final beta testing and revision, the efficacy of the PSMP will be examined in a longitudinal study. Approximately 80 million people in the United States suffer from chronic pain. Due to the high costs of health care, increased demand for services, and dwindling access to multidisciplinary treatment programs, the need for alternative, cost-effective interventions is great. The purpose of the proposed project is the development of one such alternative, the Pain Self-Management Program (PSMP), a web-based psychoeducational self-help system for adults with chronic pain. The program is based on fundamental cognitive-behavioral principles that have been effectively applied in clinical practice, group interventions, and self-help books. The PSMP has the potential to provide scientifically sound information to large numbers of individuals with chronic pain at low cost.