Cognitive Behavioral Chronic Pain Trial Among Rural Minorities and non-Minorities

描述（由申请人提供）：生活在农村地区的个人慢性疼痛的发生率很高。认知行为疗法（CBT）是一种被广泛接受的慢性疼痛循证心理治疗方法;其疗效已在多项随机临床试验中得到证实。然而，没有研究测试心理社会干预对农村人群慢性疼痛的治疗效果。拟议研究（R21）的主要目的是测试CBT与教育注意力控制相比对农村慢性疼痛（ICP）患者的疗效。将在两个农村卫生诊所以小组形式（6-8人）为慢性疼痛患者提供10次每周一次的CBT或教育治疗。治疗实施措施将用于确保治疗师按计划提供治疗，患者理解并实施治疗建议。本研究的具体目的如下：1）为了检验CBT团体治疗对农村ICP的疗效，我们将比较CBT结果与教育注意控制条件。我们假设CBT条件下的参与者将报告疼痛相关结果（疼痛严重程度，感知残疾，抑郁和生活质量）比对照组参与者有更大的改善。2)测试灾难化的中介作用，一种关于疼痛的负面心理设置，在农村人口的治疗结果。我们假设，疼痛灾难化将介导治疗结束时获得的治疗结果的措施。次要目的是探索基于性别、教育、收入和种族的治疗结局和治疗相关变量（治疗满意度、会议出席率、脱落率和受邀参与者与参与者的比例）的潜在差异。向农村ICP提供CBT符合《2010年健康人》的两个首要目标，即提高健康生活质量和健康生活年限，消除健康差距（卫生和公众服务部，2000年）。农村居民慢性疼痛问题的发病率很高，他们缺乏获得保健的机会。虽然慢性疼痛的心理社会治疗已被证明在城市人群中有效，但尚未在农村人群中进行系统性测试。这项研究将在亚拉巴马两个非裔美国人比例较高的农村卫生诊所测试认知行为治疗慢性疼痛的有效性。

DESCRIPTION (provided by applicant): Individuals living in a rural area have a high occurrence of chronic pain. Cognitive Behavioral Therapy (CBT) is a widely accepted evidence-based psychosocial treatment for chronic pain; its efficacy has been well established in multiple randomized clinical trials. However, there is no research testing the treatment efficacy of psychosocial interventions for chronic pain in rural populations. The primary objective of the proposed study (R21) is to test the efficacy of CBT compared to education attention control for rural individuals with chronic pain (ICPs). Ten weekly sessions of CBT or education treatment will be provided in small group format (6-8 individuals) at two rural health clinics for patients suffering from chronic pain. Treatment implementation measures will be used to ensure that therapists are delivering the treatment as planned and that patients understand and implement the treatment suggestions. The specific aims of this study are as follows: 1) To test the efficacy of CBT group treatment for rural ICPs, we will compare CBT outcomes to an education attention control condition. We hypothesize that participants in the CBT condition will report greater improvements in pain related outcomes (pain severity, perceived disability, depression, and quality of life) than control participants. 2) To test the mediational role of catastrophizing, a negative mental set about pain, on treatment outcomes in a rural population. We hypothesize that pain catastrophizing will mediate treatment outcome measures obtained at the end of treatment. A Secondary Aim is to explore potential differences in treatment outcome and treatment-related variables (treatment satisfaction, session attendance rate, drop out rate, and the ratio of invited participants versus those who participate) based on gender, education, income, and ethnicity. Providing CBT to rural ICPs is consistent with Healthy People 2010's two overarching goals of increasing the quality and years of healthy life and eliminating health disparities (DHHS, 2000). Rural citizens have a high incidence of chronic pain problems and they lack access to health care. Although psychosocial treatments for chronic pain have proven effective in urban populations, they have not been systematically tested in rural populations. This study will test the effectiveness of cognitive-behavioral treatment for chronic pain in two rural Alabama health clinics with a high percentage of African Americans.