Single Session Pain Catastrophizing Class: Efficacy & Mechanisms for Reducing Opioid Use Among Chronic Pain Patients

项目概要/摘要 阿片类药物流行是一场严重的国家危机，影响到公共卫生以及社会和经济。 美国的死亡率不断上升，令人震惊。因此，迫切需要 需要采取有效和高效率的干预措施解决类阿片使用问题，以防止类阿片滥用的风险， 最好在它建立后再处理。阿片类药物使用增加的最大预测因素之一 慢性疼痛是疼痛灾难化（PC），定义为持续的负面认知和情绪 对实际或预期疼痛的反应。未经治疗的PC可能导致阿片类药物使用增加，并增加风险 滥用和过度使用药物，特别是当手术和药理学是重点医疗 护理计划。尽管迫切需要，但没有有针对性的干预措施，有效地解决关键问题， 心理因素可能会放大疼痛，对阿片类药物的需求以及滥用风险的增加。在这 导师职业发展奖（K23），Ziadni博士将试图解决这一迫切需要的有效和 有效的解决方案。我们的小组已经开发了一个2小时的有针对性的，单次会议的疼痛灾难类（PC- 类），植根于认知行为疗法（CBT）的方法，旨在通过减少疼痛来减少阿片类药物的使用 在慢性疼痛中造成灾难性后果这种有针对性的简短治疗消除了许多现有的障碍， 负担通常的全面疼痛-CBT，如参加8次会议所需的时间，保险 覆盖范围、差旅费用、缺乏熟练的临床医生、患者流失和共同负担费用。Ziadni博士建议 实施一项随机对照试验，将PC类与健康教育对照类进行比较。在目标1中， 博士Ziadni将确定PC类药物在减少混合病因患者中阿片类药物使用的疗效 疼痛状况。对于目标2，她将收集每日数据，以便对每日数据进行分析。 灾难化的经验，以及它与阿片类药物使用的关系，以及它对治疗的动态反应。 她将使用这些日常数据来描述灾难化对阿片类药物使用的机械影响， 日常水平和前瞻性。将在术后1、3、6和12个月纵向跟踪患者结局 干预会议。该项目旨在确定实现阿片类药物有意义减少的患者 使用，这将使治疗反应者的更好的特点和完善阿片类药物减少战略。 在整个奖励期间，Ziadni博士将获得机械科学的新技能和专业知识， 阿片类药物的使用，随机对照试验的进行，以及疼痛的神经生物学机制，阿片类药物 和上瘾。为了完成拟议的研究和培训，Ziadni博士组装了一个多- 由世界级导师组成的纪律团队致力于她的成功。这项研究将建立在博士。 Ziadni的临床心理学背景和疼痛医学博士研究培训， 为她提供知识和技能，以建立一个独立的研究计划。

PROJECT SUMMARY/ABSTRACT The opioid epidemic is a serious national crisis that affects public health as well as social and economic welfare, with increasing and alarming mortality rates in the United States. Consequently, there is an urgent need for effective and efficient interventions to address opioid use to prevent the risk of opioid misuse and better address it once it is established. One of the greatest predictors for increased opioid use among patients with chronic pain is pain catastrophizing (PC), defined as persistent negative cognitive and emotional responses to actual or anticipated pain. Untreated PC can lead to increased opioid use and facilitate the risk for misuse and overuse of medications, particularly when surgery and pharmacologics are the focal medical care plan. Despite critical need, there are no targeted interventions that efficiently address the key psychological factors that can amplify both pain, need for opioids, and increased risk for misuse. In this mentored career development award (K23), Dr. Ziadni will attempt to address this urgent need for efficient and effective solutions. Our group has developed a 2-hour targeted, single-session pain catastrophizing class (PC- class), rooted in cognitive-behavior therapy (CBT) approaches, aimed at reducing opioid use by reducing pain catastrophizing in chronic pain. This targeted, brief treatment obviates many of the existing barriers and burdens to usual comprehensive pain-CBT, such as the time required to attend 8 sessions, insurance coverage, travel costs, lack of skilled clinicians, patient attrition, and copayments. Dr. Ziadni proposes to implement a randomized controlled trial comparing the PC-class to a health education control class. In Aim 1, Dr. Ziadni will determine the efficacy of the PC class in reducing opioid use among patients with mixed-etiology pain conditions. For Aim 2, she will collect daily data that will allow the conduct of analyses on the daily experience of catastrophizing and how it relates to opioid use, as well as its dynamic response to treatment. She will use this daily data to characterize the mechanistic influence of catastrophizing on opioid use both on the daily-level and prospectively. Patient outcomes will be longitudinally tracked at 1, 3, 6, and 12 months after the intervention session. This project aims to identify patients who achieve a meaningful reduction in opioid use, which will enable better characterization of treatment responders and refining opioid reduction strategies. Throughout the award period, Dr. Ziadni will obtain new skills and expertise in the mechanistic science of opioid use, the conduct of randomized controlled trials, and the neurobiological mechanisms of pain, opioids and addiction. To accomplish the proposed research and training, Dr. Ziadni has assembled a multi- disciplinary team of world-class mentors who are committed to her success. This training will build on Dr. Ziadni’s background in clinical psychology and doctoral research training in pain medicine and ultimately provide her with the knowledge and skillset to establish an independent research program.