Coping Skills Training for Spinal Cord Stimulator Patients

描述（由申请人提供）：慢性腰痛（CLBP）是500多万美国人残疾的主要原因。据估计，每年的经济影响在500亿至1000亿美元之间。这些患者的心理困扰和残疾程度是无法估量的。脊髓刺激器（SCS）植入手术是治疗CLBP患者的重要进展。SCS植入越来越普遍，每年植入数万例SCS。不幸的是，SCS植入的成功率差异很大，大多数患者在手术后仍会经历一定程度的疼痛。临床观察表明，患者应对这种疼痛的能力各不相同。本研究旨在确定围手术期疼痛应对技能训练方案是否会改善疼痛应对和疼痛管理的自我效能，并减少接受SCS手术的CLBP患者的身体残疾、心理困扰、疼痛和疼痛行为。在本研究中，128名接受SCS植入的患者将被随机分配到三种情况中的一种：1)植入手术疼痛应对技能训练（PCST-IS），该训练系统地训练患者各种认知和行为应对技能，旨在提高患者应对SCS植入手术特定挑战的自我效能感；2)慢性疼痛教育：提供慢性腰痛的性质和治疗教育的比较条件；或者，3)标准护理控制条件。治疗前后以及6个月和12个月随访时收集的评估指标包括自我效能、疼痛应对、身体残疾、心理困扰、疼痛和疼痛行为。如果围手术期疼痛应对技能培训是有效的，将为该治疗在其他疼痛相关手术干预中的进一步应用和试验奠定重要的基础。以证据为基础的心理干预可能对脊髓刺激器患者的医学管理具有重要意义。它还可能导致将心理干预更大程度地整合到因许多其他痛苦状况而接受手术的患者的标准医疗护理中。因此，这项研究最终可能导致围手术期应对技能干预，从而改善患有各种疼痛相关疾病的患者的生理和心理功能。公共卫生相关性：本研究的最终目的是寻找方法来提高接受脊髓刺激器植入的慢性腰痛患者的预后。本研究旨在检验围手术期疼痛应对技能培训是否能有效提高患者的疼痛应对能力和管理疼痛的自信心，减少患者的身体残疾、心理困扰、疼痛和疼痛行为。如果成功，这项研究可能对脊髓刺激患者的医疗管理具有重要意义，也可能导致围手术期应对技能干预，以改善患有各种疼痛相关疾病的患者的预后。

DESCRIPTION (provided by applicant): Chronic low back pain (CLBP) is a major source of disability for more than 5 million Americans. Estimates of the economic impact range from $50 to $100 billion annually. The magnitude of psychological distress and disability in these patients is immeasurable. Spinal cord stimulator (SCS) implantation surgery represents an important advance in the treatment of patients suffering from CLBP. SCS implants are becoming increasingly common, with tens of thousands of SCSs implanted annually. Unfortunately, the success rate of SCS implantation varies widely, and most patients will continue to experience some degree of pain following the procedure. Clinical observations suggest that the ability of patients to cope with this pain is quite varied. The proposed study seeks to determine whether a perioperative pain coping skills training protocol will lead to improvements in pain coping and self efficacy for pain management and to reductions in physical disability, psychological distress, pain and pain behavior in patients having CLBP who undergo SCS surgery. In this study, 128 patients who are undergoing SCS implant will be randomly assigned to one of three conditions: 1) Pain coping skills training for implant surgery (PCST-IS) which systematically trains patients in a variety of cognitive and behavioral coping skills designed to increase their self efficacy with regard to their abilities to address specific challenges posed by SCS implant surgery; 2) Chronic pain education a comparison condition providing education on the nature and treatment of chronic low back pain; or, 3) standard care control condition. Assessment measures to be collected before and after treatment and at 6 and 12 months follow up include measures of self efficacy, pain coping, physical disability, psychological distress, pain, and pain behavior. If peri surgical pain coping skills training is effective, it would lay important groundwork for further application and testing of this treatment in other pain related surgical interventions. An evidence based psychological intervention could have significant implications for the medical management of spinal cord stimulator patients. It also could lead to a greater integration of psychological interventions into standard medical care for patients undergoing surgery for a number of other painful conditions. As a result, this research ultimately could lead to peri surgical coping skills interventions that could improve the physical and psychological functioning of patients suffering from a variety of pain related conditions. Public Health Relevance: The ultimate goal of this research is to find ways to enhance outcomes for patients with chronic low back pain who are receiving spinal cord stimulator implants. This study will test whether peri operative pain coping skills training is effective in increasing patients' pain coping and their self confidence for managing pain and decreasing patients' physical disability, psychological distress, pain, and pain behaviors. If successful, this research could have important implications for the medical management of spinal cord stimulator patients, and could also lead to peri surgical coping skills interventions to improve outcomes for patients suffering from a variety of pain related conditions.