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

描述(申请人提供)：居住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循证心理社会治疗慢性疼痛的方法，其疗效已经在多个随机临床试验中得到了很好的证实。然而，没有研究测试心理社会干预对农村人口慢性疼痛的治疗效果。建议的研究(R21)的主要目标是测试CBT与教育注意力控制对农村慢性疼痛患者(ICP)的疗效。将在两个乡村保健诊所以小组形式(6-8人)为慢性疼痛患者提供每周10次的CBT或教育治疗。将采用治疗实施措施，以确保治疗师按计划提供治疗，并确保患者理解并执行治疗建议。本研究的具体目的如下：1)为了检验CBT小组治疗农村ICP的有效性，我们将CBT的结果与教育注意控制条件进行了比较。我们假设，CBT条件下的参与者报告的疼痛相关结果(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)在农村人群中测试灾难(一种关于疼痛的负面心理定势)对治疗结果的中介作用。我们假设疼痛灾变将调解在治疗结束时获得的治疗结果。第二个目标是探索基于性别、教育、收入和种族的治疗结果和治疗相关变量(治疗满意度、会议出席率、辍学率和受邀参与者与参与者的比率)的潜在差异。向农村初级保健医生提供CBT与2010年健康人S的两个总体目标是一致的，那就是提高健康生活质量、延长健康生活年限和消除健康差距(卫生部，2000年)。农村居民慢性疼痛问题的发生率很高，而且他们无法获得医疗保健。虽然慢性疼痛的心理社会治疗在城市人群中被证明是有效的，但它们尚未在农村人群中进行系统的测试。这项研究将在阿拉巴马州两家非裔美国人比例较高的乡村健康诊所测试认知行为疗法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.