Transcending COVID-19 barriers to pain care in rural America: Pragmatic comparative effectiveness trial of evidence-based, on-demand, digital behavioral treatments for chronic pain

项目总结 新冠肺炎疫情以不同的方式影响了每个人。对于来自美国农村的人来说， 慢性病，特别是那些经历疼痛的人，大流行病不仅会加剧疼痛，而且还可能 引发焦虑、抑郁、失眠和药物滥用。这种心理痛苦因以下原因而加剧 身体和社会孤立，害怕寻求面对面的访问，以及在治疗期间获得临床护理的能力减弱 大流行。医生和卫生系统伸出援手的一种方式是通过视频访问，患者和他们的 供应商通过互联网进行在线交流。然而，视频访问仍然有限制。因此，我们可以提供帮助 用其他技术来支持他们。除了视频访问，还有一些基于家庭的程序，患者可以 管理自己，以帮助管理他们的痛苦。这些经过验证的计划可以解决人员短缺的问题， 用于远距离连接世界上的任何人，并可在患者的时间和地点使用 选择。 在这项研究中，我们将比较患者可以使用的两种可用的、基于证据的数字化治疗方案 在家。目的是观察一种方法是否比另一种方法更好，以及某些患者是否对其中一种方法有反应 比其他人更多。第一个程序是一款可以在任何智能手机或电脑上运行的应用程序。该计划 提供为期8周的在家课程，学习和练习有助于控制疼痛的新技能。该计划 在手机或计算机的标准屏幕上运行。第二个项目也是经过验证的，为期8周的项目， 但它使用了一种名为虚拟现实或VR的技术。VR涉及到佩戴专门的护目镜，以创建 置身3D世界的感觉。有证据表明，虚拟世界可以帮助人们学习和保留新技能 这有助于减轻疼痛。 这项研究将从加利福尼亚州、路易斯安那州和阿拉巴马州的农村社区招募300人，并随机 它们被转换成2D或3D程序。然后，我们将对患者进行为期8周的跟踪，并测量他们的疼痛 级别。我们还将测量痛苦的迹象，包括冠状病毒相关的焦虑，以及测量 治疗疼痛的药物，如阿片类药物，以及疼痛对整体生活质量的影响。为了进行这项研究， 我们将要求患者定期在线完成短期调查，并允许研究团队 从电子健康记录中收集信息。我们与患者合作伙伴共同开发了这项研究 美国慢性疼痛协会(ACPA)，他们将成为整个研究团队的一部分 进行、分析和报告研究。这一结果将帮助患者、医生和卫生系统做出决定 如何最好地管理基于家庭的、患者管理的数字疼痛治疗计划，并将提供 关于如何为合适的患者选择合适的治疗方案的建议。

PROJECT SUMMARY The COVID-19 pandemic has affected everyone in different ways. For people from the rural America with chronic diseases, particularly those who experience pain, the pandemic can not only worsen pain, but also it can trigger anxiety, depression, trouble sleeping, and substance use. This psychological distress is exacerbated by physical and social isolation, fear of seeking in-person visits, and diminished ability to access clinical care during the pandemic. One way doctors and health systems are reaching out is by video visits, where patients and their providers communicate online via the Internet. However, video visits still have limits. Therefore, we can help support them with other techniques. Beyond video visits, there are home-based programs that patients can administer themselves to help manage their pain. These proven programs can overcome staffing shortfalls, be used across long distance to reach anyone in the world and can be used at the time and place of the patients' choosing. In this study, we will compare two available, evidence-based, digital treatment programs that patients can use at home. The goal is to see if one approach is better than the other, and whether certain patients respond to one more than the other. The first program is an app that can run on any smartphone or computer. The program offers an 8-week, at-home curriculum to learn and practice new skills that can help manage pain. The program runs on a standard screen on your phone or computer. The second program is also a proven, 8-week program, but it uses a technology called virtual reality, or VR. VR involves wearing specialized goggles that create a sensation of being in a 3D world. Evidence shows that virtual worlds can help people learn and retain new skills that help reduce pain. The study will recruit 300 people from rural communities in California, Louisiana, and Alabama and randomize them into either the 2D or 3D programs. We will then follow patients for 8 weeks days and measure their pain levels. We will also measure signs of distress, including Coronavirus-related anxiety, along with measuring medications used for pain, such as opioids, and the impact of pain on overall quality of life. To conduct the study, we will ask patients to periodically complete short surveys online and allow permission for the research team to collect information from the electronic health record. We developed this study working with patient partners from the American Chronic Pain Association (ACPA), and they will be part of the research team throughout the conduct, analysis, and reporting of the study. The results will help patients, doctors, and health system decide how best to administer home-based, patient-administered, digital treatment programs for pain, and will offer recommendation on how to select the right treatment for the right patient.