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A sequenced-strategy for improving outcomes in patients with knee osteoarthritis pain

改善膝骨关节炎疼痛患者预后的序贯策略

基本信息

批准号：
10700013
负责人：
Claudia Michelle Campbell
金额：
$ 116.41万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-25 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10700013
关键词：
Adverse effects Advocate Affect Anti-Inflammatory Agents Behavior Therapy Behavioral Body mass index Caring Characteristics Chronic Clinical Cognitive Therapy Coping Skills Degenerative polyarthritis Development Economic Burden Effectiveness Elderly Exercise Exhibits Goals Guidelines Hyaluronic Acid Individual Injections Internet Intervention Intra-Articular Injections Joints Knee Osteoarthritis Knowledge Life Expectancy Local Anesthetics Measures Medicine Mental Depression Methods Modeling Nerve Nerve Block Norepinephrine Operative Surgical Procedures Opioid Outcome Pain Pain management Participant Patient Selection Patients Persistent pain Pharmaceutical Preparations Pharmacological Treatment Pharmacotherapy Phase Phenotype Physical Function Population Prediction of Response to Therapy Procedures Public Health Quality of life Radiofrequency Interstitial Ablation Randomized Randomized, Controlled Trials Recommendation Reporting Research Personnel Risk Role Selection for Treatments Self Management Sequential Treatment Serotonin Sleep Societies Standardization Steroids Structure Testing Therapeutic Therapeutic Intervention Time Tramadol chronic pain clinical pain comparative effectiveness compare effectiveness cost effective disability duloxetine effectiveness evaluation effectiveness testing effectiveness trial evidence based guidelines experience functional disability functional improvement functional outcomes global health impression improved improved outcome inhibitor innovation knee pain knee replacement arthroplasty model design multidisciplinary non-opioid analgesic opioid sparing opioid therapy opioid use osteoarthritis pain pain catastrophizing pain model pain outcome pain reduction pain relief patient subsets precision medicine psychologic psychosocial randomized trial resilience response reuptake skills training standard of care telehealth treatment comparison treatment response treatment strategy

项目摘要

PROJECT SUMMARY/ABSTRACT Knee osteoarthritis (KOA) is one of the leading causes of chronic pain and disability worldwide, affecting over 30% of older adults and represents a major global health and economic burden to individuals and society. The rates of KOA have more than doubled in the past 70 years and continue to grow sharply, given increases in life expectancy and population BMI. Surgery is often employed to treat KOA, but it associated with a high rate of persistent pain, and is not a permanent solution. Numerous nonsurgical therapies have been advocated to treat pain in patients with KOA. However, stand-alone conservative treatments including non-opioid medications and joint injections provide only limited pain relief and functional improvement in a subset of knee OA sufferers. This has led to a high rate of opioid use in this population. The overarching goal of this proposal is to conduct a sequential parallel group randomized controlled trial (RCT) to rigorously evaluate the comparative-effectiveness of conservative behavioral and non-opioid pharmacological treatments (Phase I) and, among non-responders, the benefits of nonsurgical procedural interventions (Phase II) in three inter- related Aims. Aim 1 will evaluate the effectiveness of individual and combined online cognitive behavioral therapy (PainTRAINER) and pharmacologic treatment (duloxetine) in improving pain and function for KOA patients compared to standard of care. Aim 2 will determine if genicular nerve radiofrequency ablation (RFA) or intra-articular injection of hyaluronic acid and steroid are more effective in improving outcomes than local anesthetic nerve block or SOC and help establish the role of these interventional treatments in the overall management of pain in KOA patients. Patients that have failed Phase I treatment will be provided with an opioid for severe pain management, if appropriate, allowing us to examine the opioid-sparing effects of these procedures in a subset of participants. Aim 3 will test whether clinical and psychosocial phenotypes predict short- and long-term treatment response. Our study involves comprehensive and innovative approaches that have never before been employed in this context, including: a multidisciplinary cadre of investigators conducting the largest randomized trial to date evaluating behavioral, pharmacotherapy and nonsurgical procedural interventions for KOA; a stepped-care, factorial design model that allows for more than two dozen pair-wise treatment comparisons; phenotyping to identify responders and improve selection for each therapy (i.e. precision medicine), which is expected to refine outcomes and reduce unnecessary interventions. The results, which will follow pragmatic principles in order to maximize the information provided to stakeholders, will examine not only the effectiveness of each tested intervention but also provide meaningful information regarding effectiveness across key subgroups of patients. The knowledge gained will contribute to the development of translatable therapeutic strategies for the treatment of patients with KOA pain that will lead to opioid sparing effects.

项目摘要/摘要膝骨性关节炎(KOA)是全世界慢性疼痛和残疾的主要原因之一，影响超过 30%的老年人，对个人和社会来说是一个重大的全球健康和经济负担。这个在过去的70年里，膝关节骨质疏松症的发生率增加了一倍多，而且由于生活水平的提高，这种比率还在继续急剧增长预期和人口BMI。手术通常被用来治疗膝关节骨性关节炎，但它与高比率的持续的疼痛，并不是治标不治本。许多非手术疗法被提倡用来治疗膝关节骨性关节炎患者的疼痛。然而，包括非阿片类药物在内的独立保守治疗药物和关节注射只能有限地缓解膝关节的疼痛和改善其功能骨性关节炎患者。这导致了这一人群中阿片类药物的高使用率。这项提案的首要目标是是进行序贯平行分组随机对照试验(RCT)，以严格评价保守行为疗法和非阿片类药物疗法的疗效比较(第一阶段) 在无反应者中，非手术程序干预(第二阶段)在三个中间阶段的好处相关目标。目标1将评估个体和组合在线认知行为的有效性治疗(Paintriner)和药物治疗(度洛西汀)改善膝关节骨性关节炎的疼痛和功能将患者与标准护理进行比较。目标2将确定膝神经射频消融术(RFA) 关节内注射透明质酸和类固醇比局部注射更有效麻醉神经阻滞或SOC，并有助于确定这些介入治疗在总体上的作用膝关节骨性关节炎患者的疼痛管理。第一阶段治疗失败的患者将获得用于剧烈疼痛管理的阿片类药物，如果合适，允许我们检查这些药物的阿片类药物的节制效果参与者子集中的程序。目标3将测试临床和心理社会表型是否能预测短期和长期治疗反应。我们的研究涉及全面和创新的方法，以前从未在这种情况下受雇，包括：一支多学科调查队伍进行迄今为止最大规模的随机试验，评估行为、药物治疗和非手术治疗 KOA的程序性干预；一种阶梯式护理析因设计模型，允许超过24个配对治疗比较；表型分型以确定应答者并改进每种治疗的选择 (即精准医学)，预计将改进结果并减少不必要的干预。这个结果将遵循务实原则，以最大限度地向利益攸关方提供信息，将不仅要检查每个经过测试的干预措施的有效性，还要提供有意义的信息关于关键患者亚组的有效性。所获得的知识将有助于开发可翻译的治疗策略来治疗膝关节骨性关节炎患者，这将导致阿片类药物的节制作用。