Cognitive Behavioral Smoking Cessation Intervention for Adults with Chronic Pain

描述(申请人提供)：虽然数百万患有慢性疼痛的成年人吸烟，但对慢性疼痛和戒烟之间的联系知之甚少。帮助患有慢性疼痛的人戒烟很重要，因为与患有慢性疼痛的非吸烟者相比，吸烟者的疼痛相关结果更差。然而，我们的初步数据表明，目前可用的戒烟干预措施可能对患有慢性疼痛的吸烟者无效，这表明需要专门为这些人设计的干预措施。这一建议的概念基础是社会认知理论。本研究项目的主要目的是开发一种认知行为戒烟干预措施，专门用于吸烟者正在接受慢性疼痛治疗的门诊临床环境中。次要目标包括基于我们的理论模型的认知行为干预从基线到治疗结束的变化机制，包括自我效能感、抑郁、疼痛相关的情感困扰和疼痛相关的焦虑。该项目将分两个阶段进行。在第一阶段，我们将采用参与性研究方法开发一种认知行为戒烟干预措施，专门用于慢性疼痛的门诊实践环境。参与性研究方法将利用线人访谈和焦点小组，涉及慢性疼痛患者和具有慢性疼痛和戒烟专业知识的卫生保健提供者。这项工作还将包括编写一份治疗手册，培训具有戒烟和慢性疼痛专业知识的护士顾问，并对10名吸烟者进行试点测试。第二阶段将包括一项临床试验，采用随机、两组设计，在第4周和第26周重复评估吸烟状况。有慢性疼痛的吸烟者将被随机分配到接受新开发的认知行为戒烟干预(N=30)或短暂戒烟干预(N=30)，这是我们机构目前的护理标准。在我们的初步研究中使用了短暂戒烟干预，没有慢性疼痛患者戒烟。在第4周和第26周自我报告戒烟将使用唾液可替宁试剂盒进行生物学确认。在项目结束时，多学科团队将开发出一种戒烟干预措施，旨在向患有慢性疼痛的普通流动吸烟者传播。公共卫生相关性：数以百万计的慢性疼痛患者吸烟，我们的初步研究表明，目前可用于帮助人们戒烟的策略可能对慢性疼痛患者无效。这一点很重要，因为与患有慢性疼痛的不吸烟者相比，患有慢性疼痛的吸烟者与疼痛相关的健康结果更差。本研究项目的主要目的是为患有慢性疼痛的吸烟者开发一种在门诊临床环境中特定使用的戒烟干预措施。

DESCRIPTION (provided by applicant): While millions of adults with chronic pain smoke, little is known about the associations between chronic pain and smoking cessation. Helping individuals with chronic pain to stop smoking is important in that pain- related outcomes are worse for smokers compared to nonsmokers with chronic pain. However, our preliminary data suggests that currently available smoking cessation interventions may not be effective for smokers with chronic pain, indicating the need for an intervention designed specifically for these individuals. The conceptual basis for this proposal is social cognitive theory. The primary aim of this research project is to develop a cognitive behavioral smoking cessation intervention for specific use in an outpatient clinical setting where smokers are receiving treatment for chronic pain. Secondary aims include examination of the mechanisms of change from baseline to end of treatment associated with the cognitive behavioral intervention based on our theoretical model, including self-efficacy, depression, pain-related affective distress, and pain-related anxiety. The project will be conducted in two phases. In Phase I, we will employ participatory research methods to develop a cognitive behavioral smoking cessation intervention for specific use in an outpatient practice environment for chronic pain. The participatory research methods will utilize informant interviews and focus groups involving individuals with chronic pain and health care providers with expertise in chronic pain and smoking cessation. This work will also involve development of a treatment manual, training of nurse counselors with expertise in smoking cessation and chronic pain, and pilot testing with 10 smokers. Phase 2 will consist of a clinical trial utilizing a randomized, two-group design with repeated assessment of smoking status at weeks 4 and 26. Smokers with chronic pain will be randomly assigned to receive the newly developed cognitive behavioral smoking cessation intervention (N = 30) or a brief smoking cessation intervention (N = 30), which is the current standard of care at our institution. The brief smoking cessation intervention was used in our preliminary study and no individual with chronic pain quit smoking. Self-report smoking cessation at weeks 4 and 26 will be biologically confirmed using a saliva cotinine kit. At project conclusion, the multidisciplinary team will have developed a smoking cessation intervention designed for dissemination to a general ambulatory population of smokers with chronic pain. PUBLIC HEALTH RELEVANCE: Millions of individuals with chronic pain smoke and our preliminary research suggest that currently available strategies to help people quit smoking may not be effective for individuals with chronic pain. This is important in that smokers with chronic pain have worse pain-related health outcomes compared to nonsmokers with chronic pain. The primary aim of this research project is to develop a smoking cessation intervention for specific use in an outpatient clinical setting for smokers with chronic pain.