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.

持续性手术后疼痛（PPSP）和功能受损在接受的患者中很常见 总膝关节镜检查（TKA）。超出预期治愈时期的疼痛可能是毁灭性的 一个人的幸福感。实际上，疼痛的严重程度与对身体功能的不利影响高度相关。 有力且一致的证据表明，动画和/或抑郁症状高的患者（困扰）患者 手术前有PPSP的风险。退伍军人面临后手术问题的风险特别高，因为 80％的人在手术前经历了一定程度的心理困扰，50％的人报告在 定期。预定的手术是医疗系统的关键点，可提供重要的 识别和解决这些问题的机会。接受和承诺疗法（ACT）是一种反式 诊断和基于证据的治疗抑郁，焦虑和慢性疼痛。重要的是，行为一直是 有效地采用各种治疗递送格式实施，包括密集的1天小组研讨会。 该应用程序提出了一个多站点，双盲，两臂，平行，随机对照试验 将ACT干预措施与注意力控制（AC）干预的影响 ppsp遵循TKA。在TKA之前，具有高疼痛和严重困扰的退伍军人将被确定为 “危险。”这项研究的主要目的是检查与AC在疼痛和疼痛方面相比的ACT效率 TKA后6周，3个月和6个月在高风险的退伍军人中发挥作用。次要目的是检查 与AC相比，ACT的影响对抑郁症状和焦虑症状以及应对技巧的影响。调解 将进行分析以检查抑郁，焦虑和应对技巧的变化是否具有 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之后的药物和非药理疼痛管理策略。当前的建议 基于R34资助的初步研究的有希望的结果。 在手术前为患有抑郁症和焦虑症状的人提供这种疗法 预防手术后PPSP和功能受损的目的是创新的。它有潜力 改变临床实践，从专注于术后疼痛的管理到预防AT-的慢性疼痛 冒险个人。该项目结合了参加参加的退伍军人的跨学科方法 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。这是有可能翻译有关有效治疗困扰和 慢性疼痛，以防止手术不良。该格式是简短且创新的，为最佳提供了潜力 治疗依从性，参与的可接受性和广泛的部署练习设置。最后，更多 集中且限时的方法可以在短时间内完成，例如以前 外科手术。