Chronic Pain Self-Management for the Elderly

慢性肌肉骨骼疼痛是老年人的常见问题，通常与严重的身体残疾和社会心理问题有关。随着老年人口的增长，慢性疼痛的个人和社会负担将会升级。本研究的目的是评估自我管理团体干预对慢性肌肉骨骼疼痛的社区退休老人减轻疼痛和改善功能的效果。尽管自我管理方法已被证明对几种慢性疼痛状况有效，但很少有先前的研究关注老年人，特别是那些中老年（75-84岁）和老年（85岁以上）亚组。一项随机临床试验将评估这种干预的效果，与教育书籍干预相比，在改善身体和社会功能，减少疼痛强度和抑郁方面，短期和一年的随访。此外，本研究将测试基于认知行为理论的预测，关于信念和应对策略的变化与功能、抑郁和疼痛强度的变化之间的关系。本研究的具体目的是：(1)评价慢性疼痛自我管理小组（SMG）干预与教育书本控制条件（book）干预在减轻退休社区老年人疼痛、抑郁和改善功能方面的效果；(2)确定SMG参与与特定疼痛相关信念和应对策略变化的关联程度，以及这些过程变量的变化与结果（身体和社会功能、疼痛强度和抑郁）变化的关联程度。这项研究将在一个新颖的治疗环境中进行——研究参与者居住的退休公寓和社区。这些治疗场所充分利用了居民现有的社会和医疗资源，并在研究完成后为广泛采用干预措施提供了独特的机会。

Chronic musculoskeletal pain is a common problem in the elderly, and is often associated with significant physical disability and psychosocial problems. As the population of older adults grows, the personal and societal burden of chronic pain will escalate. The purpose of this study is to evaluate the efficacy of a self-management group intervention in decreasing pain and improving functioning among elderly retirement community residents with chronic musculoskeletal pain. Although self- management approaches have been shown to be effective for several chronic pain conditions, little prior research has focused on older adults, particularly those in the mid-old (75-84 years) and old-old (over 85 years) subgroups. A randomized clinical trial will evaluate the efficacy of this intervention, as compared with an educational book intervention, in improving physical and social functioning, and decreasing pain intensity and depression, short-term and at one year follow-up. In addition, this research will test predictions based on cognitive-behavioral theory concerning the relationships of changes in beliefs and coping strategies to changes in functioning, depression, and pain intensity. The specific aims are: (1) evaluate the efficacy of a chronic pain self-management group (SMG) intervention, as compared with an educational book control condition (BOOK), in decreasing pain and depression and improving functioning among elders living in retirement communities; and (2) determine the extent to which SMG participation is associated with changes in specific pain-related beliefs and coping strategies, and the extent to which changes in these process variables are associated with changes in outcomes (physical and social functioning, pain intensity, and depression). The study will be conducted in a novel treatment setting - the retirement apartments and communities in which study participants live. These treatment venues capitalize on the social and healthcare resources already available to residents, and offers unique opportunities for widespread adoption of the intervention subsequent to the completion of the study.