Chronic pain management in primary care

这项研究旨在寻求一种更有效且更具成本效益的医疗护理和自我护理整合，以治疗初级护理环境中的慢性和复发性疼痛。 目标1：确定用于分析TMD疼痛、头痛和背痛患者的自动化医疗保健和药物使用数据的改进方法。确定长期频繁使用医疗保健和止痛药治疗这些疾病的潜在可改变的决定因素。研究一：我们将在五年的时间跨度内研究医疗保健和处方药用于疼痛的决定因素。将评估自动化医疗保健和药物使用数据的分析方法，以测试更强大和信息量更大的方法。使用改进的分析方法，我们将评估患者变量预测和解释5年时间跨度内TMD（n=391）、背痛（n=833）和头痛（n=869）患者频繁使用医疗保健、阿片类药物和镇静催眠药物的能力。目的2：评估由阶梯护理模式指导的自我护理小组干预措施的有效性。研究二：作为当前计划项目的一部分，1996-98年启动的两项自我护理组（SCG）随机对照试验的数据将用于确定影响SCG长期有效性的因素（参与、基线严重程度、自我护理取向、预后变量）。研究三：一项新的随机对照试验将评估完全融入初级保健的自我护理小组。本试验将评估自我护理组在积极招募的背痛患者（n=250）中的初始获益和长期有效性。干预将针对持续活动受限和背痛医疗保健使用率较高的患者{{持续活动受限的患者将根据阶梯式护理方案接受更强化的干预}}。患者将在随机化后2、6、12和{{24}}个月接受随访。主要结局将是活动受限（罗兰残疾评分，增加了有关职业角色残疾的项目）。目的3：评估自我护理小组（SCG）对长期医疗保健和处方药使用的影响。确定SCG对医疗保健费用的影响。 研究四：使用自动化的医疗保健和药物使用数据以及改进的分析方法，我们将研究SCG对以下方面的长期影响：（1）医疗保健的使用;（2）处方止痛药的使用;（3）背痛的医疗保健成本（来自三项SCG试验的总n =731）。由于SCG干预措施已被证明可以减少担忧，增强自我护理的信心，并减少活动限制，因此本研究将提供一个实验测试，以确定修改这些因素是否会减少随后的医疗保健使用。

This research seeks a more effective and cost-effective integration of medical care and self-care for chronic and recurrent pain in pr5imary care settings. Aim 1: Identify improved methods for analysis of automated health care and medicine use data for TMD pain, headache and back pain patients. Identify potentially modifiable determinants of long-term frequent use of health care and pain medications for these conditions. Study One: We will study determinants of health care and prescription medicine use for pain over a five-year time span. {{Methods for analysis of automated health care and medicine use data will be assessed to test more powerful and informative approaches. Using improved analytic methods,}} we will assess the ability of patient variables to predict and explain frequent use of health care, opioid medications and sedative- hypnotic medications for patients with TMD (n=391), back pain (n=833) and headache (n=869) over a five year time-span. Aim 2: Evaluate the effectiveness of Self-Care Group interventions guided by a stepped care model. Study Two: Data from two randomized controlled trials of Self- Care Groups (SCG) initiated in 1996-98) as part of the current Program Project will be used to identify factors influencing the long-term effectiveness of SCG (participation, baseline severity, self-care orientation, prognostic variables). Study Three: A new randomized controlled trial will evaluate Self-Care Groups fully integrated into primary care. This trial will evaluate the initial benefits and the long-term effectiveness of Self-Care Groups among actively recruited back pain patients (n=250). The intervention will target patients with enduring activity limitations and higher use of health care for back pain {{Patients with continuing activity limitations will receive more intensive intervention according to a stepped care protocol.}} Patients will be followed-up 2, 6, 12 and {{24}} months after randomization. The primary outcome will be activity limitations (Roland Disability Score with added items concerning occupational role disability). Aim 3: Assess the impact of Self-Care Groups (SCG) on long-term health care and prescription medication use. Determine the effect of SCG on health care costs. Study Four: Using automated health care and medicine use data and improved analytic methods, we will investigate the long-term effects of SCG on: (1) use of health care; (2) use of prescription pain medications; and (3) health care costs for back pain (total n from three SCG trials=731). Since the SCG interventions have been shown to reduce worry, enhance confidence in self-care, and reduce activity limitations, this research will provide an experimental test of whether modifying these factors reduces subsequent use of health care.