Telephone Cognitive Behavior Therapy for OEF Veterans with Pain

描述(由申请人提供)： 尽管越来越多的经验证据表明，旨在改善应对技能的认知行为疗法对患有慢性疼痛的个人是有益的，但获得这些干预措施的机会往往有限。慢性疼痛在OEF/OIF退伍军人中非常普遍。这项研究的主要目的将是测试电话传递的认知行为疗法在患有慢性疼痛的部署后退伍军人中管理慢性疼痛的有效性。第二个目标将是确定这种干预措施促进疼痛管理和成功调整OEF/OIF退伍军人适应慢性疼痛的机制。主要的假设是，与接受电话传递的疼痛教育的患者相比，接受电话传递的认知行为疗法的患者将在与疼痛相关的应对技能、减少情绪困扰和提高生活质量方面显示出显著的改善。为了实现这些目标，将对150名慢性疼痛患者进行双臂随机临床试验，这些患者来自旧金山退伍军人医疗中心的初级保健诊所以及圣布鲁诺、圣罗莎、尤基亚和尤里卡的附属退伍军人管理局社区门诊诊所。目前登记的疼痛障碍患者包括肌肉拉伤和炎症、神经损伤或中枢神经系统功能障碍，将被邀请参加。在研究组1中，患者将接受电话传递的认知行为疗法(T-CBT)；在研究组2中，患者将接受与研究组1在接触时间方面相匹配的电话传递的疼痛教育(T-EDU)。两组患者都将在20周内接受12次电话个体化治疗。疼痛控制结果将在10周(治疗中期)、20周(治疗后)、32周(3个月随访)和46周(6个月随访)进行评估。结果变量将包括疼痛症状、功能水平、应对和情绪困扰的衡量标准。样本大小将提供大于80%的力量来检测组之间的显著差异，双尾阿尔法为0.05。研究假设、评估方法和干预程序均基于慢性疼痛的认知-行为模型。 公共卫生相关性： 慢性疼痛是美国的一种流行病，也是一个严重的公共卫生问题。疼痛已被确定为VHA初级保健环境中最常见的主诉之一。在VHA，大约50%在初级保健环境中看到的退伍军人报告慢性疼痛。慢性疼痛在OEF/OIF退伍军人中非常普遍。尽管现在跨学科疼痛管理计划中普遍使用旨在提高应对技能的心理干预措施，但由于距离临床护理和疼痛障碍的致残影响，获得这些计划的机会往往受到限制。此外，面对面认知行为疗法治疗慢性疼痛的研究中的辍学率是有问题的。如果假设得到支持，退伍军人事务部将在社区门诊(CBOC)的初级保健环境中对慢性疼痛进行有效的心理社会治疗。

DESCRIPTION (provided by applicant): Although there is growing empirical evidence that cognitive behavior therapy aimed at improving coping skills is beneficial for individuals who suffer from chronic pain, access to these interventions is often limited. Chronic pain is highly prevalent in OEF/OIF veterans. The primary aim of this study will be to test the effectiveness of telephone- delivered cognitive-behavior therapy in the management of chronic pain among post- deployment veterans with chronic pain. A secondary aim will be to determine mechanisms by which this intervention facilitates pain management and successful adjustment of OEF/OIF veterans to chronic pain. The major hypothesis is that patients who receive telephone-delivered cognitive-behavior therapy will show significant improvements in pain-related coping skills, reduced emotional distress, and increased quality of life compared with those who receive telephone-delivered pain education. To achieve these aims, a two-arm randomized clinical trial will be conducted with 150 individuals who suffer from chronic pain, recruited from primary care clinics at the VA Medical Center in San Francisco and affiliated VA Community-based Outpatient Clinics in San Bruno, Santa Rosa, Ukiah, and Eureka. Currently enrolled patients with pain disorders involving muscle strain and inflammation, trauma to nerves, or central nervous system dysfunction will be invited to participate. In Study Arm 1, patients will receive telephone-delivered cognitive behavior therapy (T-CBT); and in Study Arm 2, patients will receive telephone-delivered pain education (T-EDU) matched with Study Arm 1 for amount of contact time. Patients in both groups will receive 12 sessions of telephone- delivered individual therapy over a 20-week period. Pain management outcomes will be measured at 10 weeks (mid-treatment), 20 weeks (post-treatment), 32 weeks (3-month follow-up), and 46 weeks (6-month follow-up). Outcome variables will include measures of pain symptoms, level of functioning, coping, and emotional distress. The sample size will provide greater than 80% power to detect significant differences between groups, at a two-tailed alpha of 0.05. The study hypothesis, assessment methodology, and intervention procedures are based on the cognitive-behavioral model of chronic pain. PUBLIC HEALTH RELEVANCE: Chronic pain represents an epidemic in the United States and a serious public health problem. Pain has been identified as one of the most frequent presenting complaints in VHA primary care settings. In the VHA, approximately 50% of veterans seen in primary care settings report chronic pain. Chronic pain is highly prevalent among OEF/OIF veterans. Although psychological interventions aimed at improving coping skills are now commonly used within interdisciplinary pain management programs, access to these programs is often limited due to the distance from clinical care and disabling impact of pain disorders. In addition, the dropout rate in studies of face-to-face cognitive behavior therapy for chronic pain is problematic. If the hypotheses are supported, the VA will have a validated psychosocial treatment for chronic pain in primary care settings at Community Based Outpatient Clinics (CBOCs).