Mindful Action for Pain: An Integrated Approach to Improve Chronic Pain Function

正念疼痛行动：改善慢性疼痛功能的综合方法

• 批准号: 10396993
• 负责人: Matthew Herbert
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10396993
• 关键词: Address; Adherence; Affect; Attention; Awareness; Client satisfaction; Clinical; Clinical Research; Clinical Trials; Cognitive Therapy; Dose; Economic Burden; Emotions; Evidence based treatment; Expectancy; Feeling; Future; Goals; Gold; Health Care Costs; Individual; Intervention; Intervention Trial; Investigation; Lead; Life; Light; Measures; Mediating; Meditation; Mentors; Methods; Modeling; Outcome; Outcome Measure; Pain; Pain interference; Pain management; Participant; Patient Outcomes Assessments; Phase; Physical Function; Physical activity; Principal Investigator; Process; Proxy; Psychological Impact; Psychophysics; Psychosocial Factor; Quality of life; Randomized; Research Personnel; Research Support; Scientist; Testing; Thinking; Training; Treatment outcome; Veterans; Veterans Health Administration; actigraphy; base; bodily sensation; chronic pain; chronic pain management; cost; design; diaries; disability; efficacy trial; evidence base; experience; falls; flexibility; functional improvement; functional outcomes; improved; indexing; innovation; meetings; military veteran; mindfulness; mindfulness intervention; mindfulness meditation; novel; pain catastrophizing; pain outcome; post intervention; psychologic; psychosocial; randomized trial; recruit; response; retention rate; social; therapy development; tool; trait

Chronic pain, defined as persistent or episodic pain that does not resolve with treatment, affects up to 50% of Veterans, costs the nation between $560 and $635 billion dollars annually, and is associated with high rates of disability and low quality of life. According to the 2009 Veterans Health Administration (VHA) Directive, the goal of pain treatment is to improve physical and psychosocial functioning, emphasizing non- pharmacological approaches, such as psychosocial interventions, to target psychosocial factors that maintain disability. Unfortunately, the gold standard psychosocial intervention for chronic pain, Cognitive Behavioral Therapy (CBT), does not reliably produce meaningful increases in function. Veterans would greatly benefit from innovative and theoretically-grounded alternative psychosocial interventions for chronic pain. An emerging scientific model that has been applied to chronic pain is the psychological flexibility (PF) model. PF refers to the ability to behave consistently with one's values even in the face of unwanted thoughts, feelings, and bodily sensations such as pain. Acceptance and Commitment Therapy (ACT) is the best known treatment derived from the PF model and is as effective as the gold standard CBT, but still falls short on achieving meaningful changes in functional improvement. Although ACT was designed to impact PF, methods from different treatment approaches are also consistent with the model. An experiential strategy that holds promise for enhancing PF is formal mindfulness meditation, a practice used to train non-judgmental awareness and attention to present-moment experiences, which has never been tested within the PF model. There is compelling theoretical and empirical rationale that the mechanisms underlying formal mindfulness meditation will bolster PF processes and thereby can be applied to facilitate functional improvement. To test this, Dr. Herbert, the principal investigator (PI), has developed a novel 8-week group-based intervention, Mindful Action for Pain (MAP), which integrates formal mindfulness meditation with experiential methods from different evidence-based treatment approaches in accordance with the PF model. MAP is designed such that daily mindfulness meditation practice is used to develop the capacity to more completely utilize strategies to address the key psychosocial barriers (e.g., pain catastrophizing) to optimal functioning. The proposed CDA-2 consists of two phases. Phase 1 (years 1 – 2) consists of using qualitative and quantitative methods to iteratively develop and refine MAP (n = 20). Phase 2 (years 3 – 5) consists of a pilot randomized trial (n = 86) of MAP vs. CBT for chronic pain (CBT-CP) in order to establish feasibility of a future large-scale trial and estimate the preliminary impact of MAP. Functional improvement will be measured by reductions in pain interference (primary clinical outcome). Further, meditation adherence will be assessed to explore dose-response relationships with functional improvement, and objective measures of physical activity (actigraphy) will be captured to explore the psychophysical impact of MAP. The PF model is a progressive scientific model that is consistent with VHA goals for chronic pain management, but so far interventions developed based on this model (i.e., ACT) are not accomplishing the goals set forth by the VHA. Therefore, we seek to fully develop and estimate the preliminary impact of a novel, integrated intervention that is consistent with the PF model. In MAP, formal mindfulness meditation and evidence-based experiential methods are taught as practical tools to help participants remain present moment focused while accepting and creating distance with ongoing unpleasant thoughts, emotions, and pain in order to actively pursue meaningful life directions. Findings from the proposed study have the potential of substantially increasing the physical and psychosocial functioning of Veterans with chronic pain, and also have the potential of reducing the social and economic burden of chronic pain.

慢性疼痛，定义为持续性或发作性疼痛，治疗后不缓解，影响高达 50%的退伍军人，每年花费国家560至6350亿美元，并与高 残疾率高，生活质量低。根据2009年退伍军人健康管理局（VHA）指令， 疼痛治疗的目标是改善身体和心理社会功能，强调非 药理学方法，如心理社会干预，以针对心理社会因素， 残疾。不幸的是，慢性疼痛的黄金标准心理社会干预，认知行为， 治疗（CBT）并不能可靠地产生有意义的功能增加。退伍军人将大大受益 从创新和理论基础的替代心理社会干预慢性疼痛。 一种已应用于慢性疼痛的新兴科学模型是心理灵活性（PF） 模型PF指的是即使面对不必要的想法，也能坚持自己的价值观的能力， 感觉和身体感觉，如疼痛。接受和承诺疗法（ACT）是最著名的 治疗源自PF模型，与金标准CBT一样有效，但仍有福尔斯不足。 在功能改进方面实现有意义的变化。虽然ACT旨在影响PF，但方法 从不同的治疗方法也符合该模型。一个经验策略， 提高PF的承诺是正式的正念冥想，一种用于训练非判断性意识的练习 以及对当下体验的关注，这一点从未在PF模型中得到过检验。有 令人信服的理论和经验的理由， 将支持PF过程，从而可以应用于促进功能改进。为了测试这个，博士。 赫伯特，首席研究员（PI），开发了一种新的8周的基于小组的干预，正念行动 疼痛（MAP），它将正式的正念冥想与不同的经验方法相结合， 根据PF模型的循证治疗方法。MAP的设计使得每天 正念冥想练习是用来发展能力，更完全地利用战略，以解决 关键的心理障碍（例如，疼痛灾难化）到最佳功能。 拟议的CDA-2包括两个阶段。第1阶段（1 - 2年）包括使用定性和 定量方法迭代开发和完善MAP（n = 20）。第二阶段（3 - 5年）包括一个试点项目， MAP与CBT治疗慢性疼痛（CBT-CP）的随机试验（n = 86），以确定未来 大规模试验和估计MAP的初步影响。功能改善将通过 疼痛干扰减少（主要临床结局）。此外，冥想坚持将被评估， 探索与功能改善的剂量反应关系，以及身体活动的客观测量 （活动记录）将被捕获，以探索MAP的心理物理影响。 PF模型是一种渐进的科学模型，与VHA慢性疼痛目标一致 管理，但到目前为止，基于这种模式开发的干预措施（即，（未完成） ”吴彦祖说。因此，我们寻求充分发展和估计一部小说的初步影响， 与PF模型一致的综合干预。在MAP中，正式的正念冥想和 以证据为基础的经验方法被教授为实用工具，以帮助参与者保持当下 集中注意力，同时接受并与持续的不愉快的想法，情绪和痛苦保持距离， 积极追求有意义的生活方向。拟议研究的结果有可能 大大增加了慢性疼痛退伍军人的身体和心理功能， 减少慢性疼痛的社会和经济负担的潜力。