Single Session Pain Catastrophizing Class: Efficacy & Mechanisms for Reducing Opioid Use Among Chronic Pain Patients

项目摘要/摘要 阿片类药物流行是一种严重的国家危机，影响公共卫生以及社会和经济。 福利，美国的死亡率不断上升，令人震惊。因此，有一个紧急的 需要有效和高效的干预措施来解决阿片类药物的使用问题，以防止阿片类药物滥用的风险和 一旦它建立起来，就更好地解决它。患者中阿片类药物使用量增加的最大预测因素之一 慢性疼痛是疼痛灾难(PC)，定义为持续的负面认知和情绪 对实际或预期的疼痛的反应。未经治疗的PC可能会导致阿片类药物的使用增加，从而增加风险 滥用和过度使用药物，特别是当外科和药理学是重点医疗时 护理计划。尽管有迫切的需求，但没有有效解决关键问题的有针对性的干预措施 可以放大疼痛、阿片类药物需求和增加滥用风险的心理因素。在这 导师职业发展奖(K23)，Ziadni博士将尝试解决这一迫切需要高效和 有效的解决方案。我们的团队已经开发了一个2小时的有针对性的单节疼痛灾难课程(PC- )，植根于认知行为疗法(CBT)方法，旨在通过减轻疼痛来减少阿片类药物的使用 在慢性疼痛中造成灾难。这种有针对性的简短治疗消除了许多现有的障碍和 日常综合性疼痛的负担-CBT，如参加8次会议所需的时间，保险 覆盖范围、旅行成本、缺乏熟练的临床医生、患者自然减员和共同支付。齐亚德尼博士建议 实施随机对照试验，将PC班与健康教育对照班进行比较。在目标1中， Ziadni博士将确定PC类药物在减少混合病因患者阿片类药物使用方面的有效性 疼痛状况。对于目标2，她将收集每日数据，以便进行每日分析 灾难的经验及其与阿片类药物使用的关系，以及其对治疗的动态反应。 她将使用这些日常数据来描述灾难对阿片类药物使用的机械影响 每日水平和前瞻性。在治疗后1、3、6和12个月对患者的预后进行纵向跟踪。 干预会议。该项目旨在确定有意义地减少阿片类药物的患者 使用，这将使更好地描述治疗应答者的特征和改进阿片类药物减少战略。 在整个获奖期内，Ziadni博士将在机械科学方面获得新的技能和专业知识 阿片类药物的使用，随机对照试验的进行，以及疼痛、阿片类药物的神经生物学机制 还有毒瘾。为了完成拟议的研究和培训，齐亚德尼博士组建了一个多个 由世界级导师组成的纪律团队致力于她的成功。此次培训将建立在Dr。 Ziadni的临床心理学和博士研究背景在疼痛医学方面的培训，并最终 为她提供建立独立研究计划所需的知识和技能。

PROJECT SUMMARY/ABSTRACT The opioid epidemic is a serious national crisis that affects public health as well as social and economic welfare, with increasing and alarming mortality rates in the United States. Consequently, there is an urgent need for effective and efficient interventions to address opioid use to prevent the risk of opioid misuse and better address it once it is established. One of the greatest predictors for increased opioid use among patients with chronic pain is pain catastrophizing (PC), defined as persistent negative cognitive and emotional responses to actual or anticipated pain. Untreated PC can lead to increased opioid use and facilitate the risk for misuse and overuse of medications, particularly when surgery and pharmacologics are the focal medical care plan. Despite critical need, there are no targeted interventions that efficiently address the key psychological factors that can amplify both pain, need for opioids, and increased risk for misuse. In this mentored career development award (K23), Dr. Ziadni will attempt to address this urgent need for efficient and effective solutions. Our group has developed a 2-hour targeted, single-session pain catastrophizing class (PC- class), rooted in cognitive-behavior therapy (CBT) approaches, aimed at reducing opioid use by reducing pain catastrophizing in chronic pain. This targeted, brief treatment obviates many of the existing barriers and burdens to usual comprehensive pain-CBT, such as the time required to attend 8 sessions, insurance coverage, travel costs, lack of skilled clinicians, patient attrition, and copayments. Dr. Ziadni proposes to implement a randomized controlled trial comparing the PC-class to a health education control class. In Aim 1, Dr. Ziadni will determine the efficacy of the PC class in reducing opioid use among patients with mixed-etiology pain conditions. For Aim 2, she will collect daily data that will allow the conduct of analyses on the daily experience of catastrophizing and how it relates to opioid use, as well as its dynamic response to treatment. She will use this daily data to characterize the mechanistic influence of catastrophizing on opioid use both on the daily-level and prospectively. Patient outcomes will be longitudinally tracked at 1, 3, 6, and 12 months after the intervention session. This project aims to identify patients who achieve a meaningful reduction in opioid use, which will enable better characterization of treatment responders and refining opioid reduction strategies. Throughout the award period, Dr. Ziadni will obtain new skills and expertise in the mechanistic science of opioid use, the conduct of randomized controlled trials, and the neurobiological mechanisms of pain, opioids and addiction. To accomplish the proposed research and training, Dr. Ziadni has assembled a multi- disciplinary team of world-class mentors who are committed to her success. This training will build on Dr. Ziadni’s background in clinical psychology and doctoral research training in pain medicine and ultimately provide her with the knowledge and skillset to establish an independent research program.