PATINA: Pain Management Training in Native American Communities

描述(申请人提供)：疼痛是人们求医的主要原因。不幸的是，疼痛治疗不足在癌症(Cohen等人，2003年；Deandrea等人，2008年)和其他疾病(Boulanger等人，2007年；Hadjistavropoulos等人，2006年)中得到了很好的记录。虽然药物仍然是对抗疼痛的第一道防线，但对认知-行为疼痛管理(CBPM)技术有效性的经验支持继续增长。单独使用或与药物治疗结合使用，CBPM技术，如横隔膜呼吸、渐进性肌肉放松和引导成像，已被证明显著减轻癌症相关和非癌症相关的疼痛。然而，目前，缺乏文化适应和提供者培训是更广泛使用这些疗法的障碍，特别是在治疗美洲印第安人(AIS)和阿拉斯加原住民(ANS)的农村和部落诊所。研究表明，文化适当性对于认知行为干预对少数民族患者的可接受性很重要。因此，这个Fast-Track应用程序建议创建一种互联网提供的、根据文化定制的多媒体培训，向服务于农村社区和AI/AN的提供者传授经验支持的CBPM技术，以便这些提供者反过来可以将这些技术传授给他们的患者。拟议的产品Patina(美洲原住民社区的疼痛管理培训)在其基于网络和互联网的CBPM技术培训方法、其文化特殊性以及在乡村医院和部落诊所环境中使用远程医疗进行形成性和评估性研究方面具有创新性。主要客户将是农村医疗保健提供者和治疗AI/AN患者的人。完成培训的单位将获得继续教育奖励。基于网络的培训结合了书本和课程的最佳特点，成本低、方便，并提供互动、反馈和练习机会。 公共卫生相关性：认知-行为疼痛管理(CBPM)技术作为全面疼痛管理方法的重要组成部分，得到了几个国家组织的大力支持。然而，缺乏提供者培训是更广泛使用它们的主要障碍，特别是在农村地区和为美洲印第安人和阿拉斯加原住民提供服务的诊所。这项提案旨在通过创建互联网提供的、根据文化定制的多媒体培训来改善公共健康，向服务于农村地区以及美洲印第安人和阿拉斯加原住民的提供者传授CBPM技术，以便这些提供者可以将这些技术传授给他们的患者。

DESCRIPTION (provided by applicant): Pain is the primary reason that people seek medical care. Unfortunately, under-treatment of pain is well- documented in cancer (Cohen et al, 2003; Deandrea et al., 2008) and other medical conditions (Boulanger et al., 2007; Hadjistavropoulos et al., 2006). While medication continues to be the first line of defense against pain, empirical support for the effectiveness of cognitive-behavioral pain management (CBPM) techniques continues to grow. Used alone or in conjunction with pharmacological treatment, CBPM techniques such as diaphragmatic breathing, progressive muscle relaxation, and guided imagery have been shown to significantly reduce both cancer- and non-cancer-related pain. Currently, however, a lack of cultural adaptation and provider training are barriers to the more wide-spread use of these treatments, especially in rural and tribal clinics that treat American Indians (AIs) and Alaska Natives (ANs). Research indicates that cultural appropriateness is important to the acceptability of cognitive behavioral interventions vis-a-vis minority patients. Therefore, this Fast-Track application proposes to create an internet-delivered, culturally- tailored multimedia training to teach empirically-supported CBPM techniques to providers serving rural communities and AI/ANs, so that these providers, in turn, can teach these techniques to their patients. The proposed product, PATINA (Pain Management Training in Native American Communities), is innovative in its web- and internet-based approach to training CBPM techniques, in its cultural specificity, and in its use of telehealth to conduct formative and evaluative research in rural hospital and tribal clinic settings. Primary customers will be rural healthcare providers and those treating AI/AN patients. Continuing education units will be awarded for completing the training. Combining the best features of books and classes, web-based training is low cost, convenient, and offers interactivity, feedback and practice opportunities. PUBLIC HEALTH RELEVANCE: Cognitive-behavioral pain management (CBPM) techniques are strongly endorsed by several national organizations as an important component of a comprehensive pain management approach. However, lack of access to provider training is a major barrier to their more wide-spread use, especially in rural areas and clinics that serve American Indians and Alaska Natives. This proposal seeks to improve public health by creating an internet-delivered, culturally-tailored multimedia training to teach CBPM techniques to providers serving rural areas and American Indians and Alaska Natives, so that these providers can teach these techniques to their patients.