Development of a Personalized Feedback Intervention Targeting Pain-Related Anxiety for Hazardous Drinkers with Chronic Pain

项目摘要/摘要 危险饮酒会导致精神和身体健康问题、残疾，并可能导致 增加过早死亡的风险3.在患有慢性疼痛的人中，危险饮酒率为 与普通人群相比有所上升5，但患有慢性疼痛的危险酒精使用者仍然是 服务不足的群体。迫切需要测试替代的和补充的方法，以 实施有效的干预措施，以减少这一高危人群中有害酒精的使用 普通人群；以综合方式这样做(即，联合针对酒精和情感机制 这可能会维持疼痛与酒精的联系)可能提供一种更有效和更有针对性的干预方法。 以疼痛相关焦虑为目标，这是一个跨诊断的易感因素，预计与两者都有关 危险饮酒和慢性疼痛6，7可能是有益的。因此，需要做更多的工作来评估 在有慢性疼痛的危险饮酒者中提高疼痛相关焦虑的目标的好处。我们的 该方法将遵循与NIH关于制定和标准化行为的指导方针一致的阶段性模型 干预措施。IA阶段的活动将包括收集迭代焦点小组(N=10)的定性反馈 细化干预内容，评价治疗可接受性和可行性。IB阶段的活动将包括 一项概念验证和高度严格的随机临床试验，旨在比较与疼痛相关的 130例慢性危险饮酒者的焦虑/酒精PFI(PA-PFI)控制PFI(C-PFI) 与疼痛相关的焦虑水平升高的疼痛。这项研究代表着 将基础研究转化为更有效的减少危险的战略的更大前景 在有医疗合并症的服务不足的人群中饮酒。拟议的干预措施将是 对数百万患有慢性疼痛的危险饮酒者具有高度的传播性和相关性。考虑到集体公众 慢性疼痛和危险饮酒对健康的影响，拟议的研究将产生增强 科学知识，增强我们对疼痛-酒精相互关系机制的理解，以及 为慢性疼痛伴疼痛升高的危险饮酒者提供新的治疗方法 焦虑，适应性强，易于在各种医疗保健环境中实施。

Project Summary/Abstract Hazardous alcohol use contributes to mental and physical health problems, disability, and may lead to increased risk of premature death3,4. Among individuals with chronic pain the rate of hazardous alcohol use is elevated compared to the general population5, yet, hazardous alcohol users with chronic pain remain an underserved group. There is a critical need to test alternative and complimentary approaches to the implementation of effective interventions to reduce hazardous alcohol use among this high-risk segment of the general population; doing so in an integrated fashion (i.e., jointly targeting alcohol and affective mechanisms that may maintain pain-alcohol associations) may provide a more efficient and targeted intervention approach. Targeting pain-related anxiety, a transdiagnostic vulnerability factor that is prospectively associated with both hazardous drinking and chronic pain6,7, may be beneficial. Thus, more work is needed to evaluate the benefit of targeting elevated pain-related anxiety among hazardous drinkers with chronic pain. Our approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral interventions. Phase IA activities will involve collecting qualitative feedback from iterative focus groups (N = 10) to refine intervention content and evaluate treatment acceptability and feasibility. Phase IB activities will include a proof-of-concept and highly rigorous randomized clinical trial designed to compare pain-related anxiety/alcohol PFI (PA-PFI) to control PFI (C-PFI) among a sample of 130 hazardous drinkers with chronic pain who have elevated levels of pain-related anxiety. This study represents an important and pivotal step in the larger landscape of translating basic research to more efficacious strategies for reducing hazardous drinking among underserved populations with medical comorbidities. The proposed intervention would be highly disseminable and relevant to millions of hazardous drinkers with chronic pain. Given the collective public health impact of chronic pain and hazardous drinking, the proposed study will yield findings that enhance scientific knowledge, enhance our understanding of mechanisms in reciprocal pain-alcohol relations, and inform the development of novel treatments for hazardous drinkers with chronic pain with elevated pain-related anxiety that are adaptable and easily implemented across a variety of healthcare settings.