Preventing Persistent Post-Surgical Pain and Dysfunction in At-Risk Veterans: Effect of a Brief Behavioral Intervention

预防高危退伍军人术后持续疼痛和功能障碍：简短行为干预的效果

• 批准号: 10064012
• 负责人: Lilian Nazar Dindo
• 金额: $ 64.1万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-08 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064012
• 关键词: Activities of Daily Living; Acute; Address; Adverse effects; Anxiety; Arthroscopy; Attention; Behavior; Behavior Therapy; Behavioral; Caring; Clinical; Coping Skills; Data; Diagnostic; Distress; Double-Blind Method; Educational workshop; Effectiveness; Equipment and supply inventories; Evidence based treatment; Exhibits; Fentanyl; Functional disorder; Funding; Future; Health; Healthcare Systems; Impairment; Individual; Intervention; Knee; Life; Measures; Mediating; Mediation; Mediator of activation protein; Medical; Mental Depression; Mental disorders; Moods; Operative Surgical Procedures; Opioid; Orthopedic Surgery; Outcome; Pain; Pain intensity; Pain management; Participant; Patients; Pattern; Personal Satisfaction; Pharmacology; Physical Function; Postoperative Pain; Postoperative Period; Powder dose form; Prevention; Prior Therapy; Process; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recovery; Reporting; Risk; Risk Factors; Schedule; Severities; Severity of illness; Site; Sleep; Source; Surveys; Symptoms; Therapeutic Intervention; Time; Translating; Veterans; Well in self; addiction; anxiety symptoms; arm; attentional control; base; chronic pain; clinical practice; cognitive function; depressive symptoms; design; effective therapy; efficacy evaluation; experience; gabapentin; healing; health care service utilization; high risk; high risk population; improved; innovation; insight; interdisciplinary approach; opioid epidemic; opioid use; optimal treatments; pain relief; pain symptom; physical insult; practice setting; prescription opioid; prevent; psychological distress; social; surgery outcome; symptomatic improvement; treatment adherence; treatment optimization; treatment response; trial comparing

Persistent post-surgical pain (PPSP) and impaired functioning are common among patients undergoing total knee arthroscopy (TKA). Pain that persists beyond the expected period of healing can be devastating to one's sense of well-being. In fact, pain severity is highly correlated with adverse effects on physical functioning. Strong and consistent evidence indicates that patients with high anxiety and/or depressive symptoms (distress) prior to surgery are at risk for PPSP. Veterans are at particularly high risk for post-surgical problems because 80% experience some level of psychological distress prior to surgery and 50% report experiencing pain on a regular basis. Scheduled surgery is a critical juncture with the healthcare system that provides an important opportunity to identify and address these issues. Acceptance and Commitment Therapy (ACT) is a trans- diagnostic and evidence-based treatment for depression, anxiety, and chronic pain. Importantly, ACT has been effectively implemented in various treatment-delivery formats, including intensive 1-day group workshops. This application proposes a multi-site, double-blind, two-arm, parallel, randomized controlled trial comparing the effects of an ACT intervention to an attention control (AC) intervention in Veterans at-risk for PPSP following TKA. Veterans with high levels of pain and significant distress prior to TKA will be identified as “at-risk.” The primary aim of this study is to examine the efficacy of ACT compared to AC on pain and functioning in at-risk Veterans at 6 weeks, 3 and 6 months post-TKA. The secondary aim is to examine the effects of ACT, compared to AC, on depressive and anxiety symptoms and on coping skills. Mediation analyses will be conducted to examine whether changes in depression, anxiety, and coping skills have an impact on pain and functioning. Finally, we will explore the impact of the current opioid restrictions on the use of pharmacological and non-pharmacological pain management strategies following TKA. The current proposal builds on promising results from a R34-funded preliminary study. Providing this therapy prior to surgery for people struggling with depressive and anxiety symptoms, for the purpose of preventing PPSP and impaired functioning following surgery, is innovative. It has the potential to change clinical practice from a focus on management of postoperative pain to prevention of chronic pain in at- risk individuals. This project incorporates an interdisciplinary approach to the care of Veterans that attends to major risk factors of postoperative sequelae that significantly impact Veterans' quality of life and healthcare utilization. Thus, it has the potential to translate what is known about effective treatments of distress and chronic pain to prevent poor surgical outcomes. The format is brief and innovative, offering potential for optimal treatment adherence, participant acceptability, and broad deployment to practice settings. Finally, this more concentrated and time-limited approach allows for completion within a short window of time, such as before surgery.

持续性术后疼痛 (PPSP) 和功能受损在接受手术的患者中很常见 全膝关节镜检查（TKA）。持续超过预期愈合时间的疼痛可能会对患者造成毁灭性的影响。 一个人的幸福感。事实上，疼痛的严重程度与对身体功能的不利影响高度相关。 强有力且一致的证据表明，患有高度焦虑和/或抑郁症状（痛苦）的患者 手术前有 PPSP 风险。退伍军人出现术后问题的风险特别高，因为 80% 的人在手术前经历过某种程度的心理困扰，50% 的人表示在手术前经历过疼痛 定期。预定手术是医疗保健系统的关键时刻，它提供了重要的 确定并解决这些问题的机会。接受与承诺疗法（ACT）是一种跨 针对抑郁、焦虑和慢性疼痛的诊断和循证治疗。重要的是，ACT 已 以各种治疗提供形式有效实施，包括为期 1 天的密集小组研讨会。 本申请提出了一项多中心、双盲、双臂、平行、随机对照试验 比较 ACT 干预与注意力控制 (AC) 干预对有以下风险的退伍军人的效果 TKA 后进行 PPSP。在 TKA 之前患有严重疼痛和严重困扰的退伍军人将被确定为 “有危险。”本研究的主要目的是检验 ACT 与 AC 相比对疼痛和疼痛的疗效。 在 TKA 后 6 周、3 和 6 个月时，高危退伍军人的功能得以发挥。第二个目的是检查 与 AC 相比，ACT 对抑郁和焦虑症状以及应对技能的影响。调解 将进行分析以检查抑郁、焦虑和应对技能的变化是否会产生影响 对疼痛和功能的影响。最后，我们将探讨当前阿片类药物限制对使用的影响 TKA 后药物和非药物疼痛管理策略的研究。目前的提案 建立在 R34 资助的初步研究的有希望的结果的基础上。 在手术前为患有抑郁和焦虑症状的人提供这种疗法， 预防 PPSP 和手术后功能受损的目的是创新的。它有潜力 将临床实践从关注术后疼痛的管理转变为预防慢性疼痛 风险个人。该项目采用跨学科方法来照顾退伍军人 术后后遗症的主要危险因素，显着影响退伍军人的生活质量和医疗保健 利用率。因此，它有可能将已知的关于痛苦和痛苦的有效治疗方法转化为知识。 慢性疼痛，以防止手术结果不佳。该格式简短而创新，提供了最佳的潜力 治疗依从性、参与者的可接受性以及在实践环境中的广泛部署。最后还有这个 集中且有时间限制的方法允许在很短的时间内完成，例如之前 外科手术。