CBT and Exercise to Reduce Pain and Substance Use in Older Adults with HIV

描述(由申请人提供)：由于艾滋病毒治疗效果的提高和这一年龄段新诊断感染率的增加，感染艾滋病毒的老年人口正在增长。慢性疼痛和药物滥用是艾滋病毒感染者普遍存在的医疗状况。首先，在长期感染艾滋病毒的人中，周围神经病和相关残疾等痛苦的情况很常见。其次，随着年龄的增长，骨性关节炎和其他肌肉骨骼疾病(如背部疼痛)等疼痛症状的发生率也会增加。第三，药物滥用在艾滋病毒携带者中很常见，并使这一人群的慢性疼痛治疗复杂化。对于既有慢性疼痛又有药物滥用的艾滋病毒感染者，综合治疗方法比单独治疗每种疾病更有可能是有益的，而加强自我管理的行为方法可以最大限度地减少止痛药的使用(对于已经在药物滥用和多药滥用中苦苦挣扎的人来说，这是一种更好的策略)。此外，慢性疼痛经常导致活动受限和相应的功能下降，除了疼痛和物质使用外，还需要针对功能障碍的干预措施。运动已被证明可以减轻疼痛，改善功能能力、信心和情绪。在也使用物质的患者中，锻炼的好处可能会导致物质使用的减少。这项研究试图结合两种循证行为疗法，CBT治疗慢性疼痛和CBT治疗药物滥用，以及锻炼、灵活性和平衡干预，太极(EX)将在小组环境中提供。运动-强化信息，这是一种在解决药物滥用和疼痛控制问题的其他研究中被证明有用的方法，将用于提高综合干预的效果。为了进行这项拟议的研究，我们将与核心社区健康中心(CCHC)合作，这是一家非营利性的社区健康中心，自1987年以来一直为加利福尼亚州洛杉矶的一个种族多元化的社区提供精神健康、药物滥用和(最近)全面的艾滋病毒医疗护理。拟议方案的目标是减少慢性疼痛和药物滥用的老年艾滋病毒感染成年人的疼痛感知、疼痛相关残疾和物质使用。这项研究的长期目标是开发一种有效的干预措施，以改善感染艾滋病毒的老年人的慢性疼痛和药物滥用，这可以由社区卫生中心为感染艾滋病毒的老年人提供可行的服务。

DESCRIPTION (provided by applicant): Older adults with HIV are a growing population due to improvements in both HIV treatment efficacy and increasing rates of newly-diagnosed infections in this age group. Chronic pain and substance abuse are prevalent medical conditions in HIV-infected persons. First, painful conditions such as peripheral neuropathy and associated disability are common among those living with long-term HIV infection. Second, advancing age is associated with increasing rates of painful conditions such as osteoarthritis and other musculoskeletal conditions (e.g., back pain). Third, substance abuse is common among persons living with HIV and complicates the treatment of chronic pain in this population. For HIV-infected persons with both chronic pain and substance abuse, an integrated treatment approach is more likely to be of benefit than treating each disorder separately, and a behavioral approach that reinforces self-management could minimize usage of pain medication (a preferable strategy for persons already struggling with substance abuse and polypharmacy). Additionally, chronic pain frequently leads to activity restriction and corresponding functional decline, and interventions that target functional impairment in addition to pain and substance use are needed. Exercise has been shown to decrease pain and improve functional capacity, confidence and mood. In patients who also use substances, the benefits of exercise may result in reduced substance use. The study proposed seeks to combine two evidence-based behavioral therapies, CBT for chronic pain and CBT for substance abuse, and an exercise, flexibility and balance intervention, tai chi, (EX) to be delivered in a group setting. Motivationa reinforcement messaging, a method proven useful in other studies addressing substance abuse and pain control, will be used to enhance the efficacy of the integrated intervention. To conduct the proposed study, we will partner with Core Community Health Center (CCHC), a non-profit, community-based health center that has provided mental health, substance abuse, and (more recently) comprehensive HIV medical care to an ethnically and racially diverse community in Los Angeles, CA since 1987. The goals of the proposed program are to decrease pain perception, pain-related disability and substance use for older, HIV-infected adults with chronic pain and substance abuse. The long-term goal of this research is to develop an effective intervention to improve chronic pain and substance abuse among older adults living with HIV that can be feasibly delivered by community-based health centers serving aging adults with HIV infection.