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心理社会问题有关。随着老年人人口的增长，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老年退休社区居民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，但先前的研究很少关注老年人，特别是中老年(75-84岁)和老年(85岁以上)亚组的老年人。一项随机临床试验将与教育书籍干预相比，评估这种干预在改善身体和社会功能、降低疼痛强度和抑郁方面的效果，并进行短期和一年的随访。此外，这项研究将测试基于认知行为理论的预测，这些预测涉及信念和应对策略的变化与功能、抑郁和疼痛强度的变化的关系。具体目标是：(1)与教育书籍控制条件(BOOK)相比，评估慢性疼痛自我管理小组(SMG)干预在减少退休社区老年人的疼痛和抑郁以及改善其功能方面的有效性；以及(2)确定SMG参与与特定疼痛相关信念和应对策略的变化的程度，以及这些过程变量的变化与结果变化(身体和社会功能、疼痛强度和抑郁)的关联程度。这项研究将在一种新的治疗环境中进行--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.