Tailored Non-Pharmacotherapy Services for Chronic Pain: Testing Scalable and Pragmatic Approaches

针对慢性疼痛的定制非药物治疗服务：测试可扩展且务实的方法

• 批准号: 10684022
• 负责人: LYNN L. DeBAR
• 金额: $ 156.63万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10684022
• 关键词: Address; Adoption; Adult; Affect; American; Anxiety; Behavior Therapy; Body Weight decreased; Caring; Clinical; Clinical Data; Cognitive Therapy; Communities; Comparative Effectiveness Research; Complex; Consent; Coping Skills; Cost Analysis; Data; Disease; Economic Burden; Electronic Health Record; Eligibility Determination; Ensure; Evaluation; Healthcare; Healthcare Systems; Information Technology; Infrastructure; Intervention; Intervention Studies; Learning; Life; Measures; Mediator; Medically Underserved Area; Mental Depression; Mental disorders; Methods; Modality; Modeling; Moods; Motivation; Opioid; Outcome; Pain; Pain management; Participant; Patient Recruitments; Patient Self-Report; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Phase; Population; Primary Care Physician; Problem Solving; Procedures; Public Health; Quality of life; Randomized; Risk; Role; Rural Population; Self Efficacy; Self Management; Services; Severities; Site; Sleep; Specialist; Substance abuse problem; System; Telephone; Testing; Time; Training; Work; arm; behavioral health; care systems; chronic pain; chronic pain management; clinical practice; comorbidity; comparative effectiveness trial; cost; data infrastructure; data quality; effective therapy; effectiveness evaluation; effectiveness outcome; evidence base; health care service organization; health care service utilization; improved; improved outcome; incremental cost-effectiveness; intervention effect; medically underserved population; online intervention; opioid epidemic; opioid therapy; opioid use; pain catastrophizing; pain model; pain reduction; patient population; performance site; practice setting; prescription opioid; primary care practice; primary endpoint; primary outcome; programs; recruit; rural area; rural underserved; secondary outcome; telehealth; telephone coaching; theories; tobacco cessation intervention; treatment as usual; underserved area; urban area

SUMMARY High impact chronic pain is persistent and limits life and work activities for one in ten adults. Evidence- based cognitive-behavioral therapy for chronic pain (CBT-CP) is widely accepted, effective, and does not rely on drugs such as opioids. Most professionals trained in CBT-CP are in urban areas, creating a need for these services in medically underserved and rural areas. Our three-arm comparative effectiveness trial will rigorously evaluate two low-cost, scalable ways to deliver CBT-CP: online via the established PainTRAINER program and by phone using PainTRAINER components. Comparison will be to usual care with a pain-management guide from the American Chronic Pain Association. Our long-term objective is increasing CBT-CP availability, especially for communities affected by the opioid crisis. Our aims: 1, In a planning phase, refine strategies to identify and recruit patients, finalize intervention procedures, and ensure data infrastructure and quality. 2, Determine the primary outcome of effectiveness of online and telephonic CBT-CP on patients' pain severity and secondary outcomes including depression, sleep, quality of life, and pain-related healthcare utilization from the electronic health record. We will examine patient and system factors that reduce pain severity and the role of theory-based mediators such as catastrophizing and self-efficacy; as well as conduct formative and summative evaluations to: understand, describe, and explain barriers and facilitators to intervention adoption, implementation and sustainability. 3, Assess the cost and incremental cost-effectiveness of online and telephonic CBT-CP compared to usual care. Our population is adults with high impact chronic pain who receive care in one four diverse healthcare systems. Eligible, consenting participants will be randomized to one of the two PainTRAINER interventions or usual care. Interventions will be 8 weekly, 45-minute sessions of the online program or telehealth-style phone coaching by trained behavioral health specialists. Self-reported pain severity and secondary outcomes will be assessed at baseline and at 3, 6, and 12 months. Regression models for longitudinal data allowing interactions between assessment time and randomization arm will be used to estimate intervention effects at 12-months, the primary endpoint This project addresses national priorities including identifying effective, low-cost, low-risk care models for pain management, especially behavioral treatments for self-management that are readily implemented and disseminated. If effective, online and telephonic PainTRAINER CBT-CP have the potential to spread nationally, similar to phone interventions for tobacco cessation and weight loss, to reduce the personal and economic burdens of chronic pain.

总结 高冲击性慢性疼痛是持续性的，并限制了十分之一成年人的生活和工作活动。证据- 基于认知行为疗法的慢性疼痛（CBT-CP）被广泛接受，有效， 依赖阿片类药物等药物。大多数接受过CBT-CP培训的专业人员都在城市地区，因此需要 在医疗条件差的地区和农村地区提供这些服务。我们的三组比较有效性试验将 严格评估两种低成本，可扩展的方式来提供CBT-CP：通过建立在线 PainTRAINER程序和电话使用PainTRAINER组件。比较将是以平常的照顾 美国慢性疼痛协会的疼痛管理指南。我们长远的目标是 增加CBT-CP的可用性，特别是对受阿片类药物危机影响的社区。我们的目标：1、在一个 规划阶段，完善策略，以确定和招募患者，最终确定干预程序， 确保数据基础设施和质量。2、确定在线和在线咨询的有效性的主要结果， 电话CBT-CP对患者疼痛严重程度和次要结局（包括抑郁、睡眠、质量）的影响 以及电子健康记录中与疼痛相关的医疗保健利用率。我们会检查病人， 降低疼痛严重程度的系统因素和基于理论的介质的作用，如灾难化 和自我效能;以及进行形成性和总结性评价：理解，描述， 解释干预措施的采用、实施和可持续性的障碍和促进因素。3、评估 与常规护理相比，在线和电话CBT-CP的成本和增量成本效益。我们 人群是在四个不同的医疗保健系统中接受护理的患有高影响慢性疼痛的成年人。 合格、知情同意的受试者将随机接受两种PainTRAINER干预之一或常规治疗。 在乎干预将是每周8次，45分钟的在线程序或远程医疗式电话会议 由训练有素的行为健康专家进行指导。自我报告的疼痛严重程度和次要结局将 在基线和3、6和12个月时进行评估。纵向数据的回归模型允许 评估时间和随机分组之间的相互作用将用于估计干预效果 12个月时，主要终点该项目涉及国家优先事项，包括确定有效的， 用于疼痛管理的低成本、低风险护理模式，特别是用于自我管理的行为治疗 容易实施和传播。如果有效，在线和电话PainTRAINER CBT-CP 有可能在全国范围内传播，类似于戒烟和体重的电话干预 损失，以减少慢性疼痛的个人和经济负担。