Preventing Persistent Post-Surgical Pain & Opioid Use in Veterans: Effect of ACT

大量退伍军人患有焦虑和抑郁等基于痛苦的疾病，使他们在手术后经历持续疼痛和长期使用阿片类药物的风险很高。这些联系是基于来自文献和我们的初步数据的强有力和一致的证据。拟议的研究增加了为期1天的接受和承诺疗法（ACT）研讨会，然后是一个单独的“助推器”会议，以减少退伍军人手术后持续疼痛和长期使用阿片类药物的风险。ACT已被证明可有效减轻慢性疼痛、焦虑和抑郁。这项初步研究将确定将ACT纳入常规治疗（TAU）的可行性和初步疗效，以在术前针对基于痛苦的风险因素。目的1是确定手术前后成功向高危退伍军人提供ACT的可行性。目的2是测试ACT对手术后疼痛和阿片类药物使用的长度和/或量的初步疗效。手术前焦虑或抑郁的退伍军人将被随机分配接受ACT加TAU或TAU。将比较两组之间的结果。目标3是看看由国家卫生研究所开发的PROMIS模块是否对评估退伍军人的疼痛和其他症状有用。这项研究的结果将用于设计和实施一项更大的、对照良好的随机临床试验，该试验将评估ACT加TAU对高危退伍军人的疗效。本研究将在爱荷华州市VA医疗保健系统进行。计划在1至3个月内进行骨科手术的退伍军人，如果焦虑或抑郁评分高，将被随机分配参加术前为期1天的ACT研讨会，术后进行个性化的“助推器”会议，或进行TAU。接受ACT的退伍军人和提供治疗的培训师将接受采访，以确定在手术前后向有风险的退伍军人提供ACT的障碍和促进因素。其他主要结局是手术后疼痛和阿片类药物的使用。可能影响这些结果的因素也将被测量，包括焦虑，抑郁，物质使用障碍，创伤后应激障碍和其他止痛药的使用。我们希望获得关于如何最好地将ACT作为需要手术的退伍军人的常规护理的一部分的重要知识，以及ACT预防术后持续性疼痛和长期使用阿片类药物的初步疗效。

A large number of veterans suffer from distress-based conditions, such as anxiety and depression, putting them at high risk of experiencing persistent pain and prolonged opioid use following surgery. These connections are based on strong and consistent evidence from the literature and our preliminary data. The proposed study adds a 1-day workshop of Acceptance and Commitment Therapy (ACT), followed by an individual “booster” session, to treatment as usual (TAU) to reduce veterans’ risk of persistent pain and prolonged opioid use following surgery. ACT has been shown to be effective in reducing chronic pain, anxiety and depression. This pilot study will establish the feasibility and preliminary efficacy of incorporating ACT into treatment as usual (TAU) to preoperatively target distress-based risk factors. Aim 1 is to establish the feasibility of successfully delivering ACT to at-risk veterans before and after surgery. Aim 2 is to test the preliminary efficacy of ACT on the length and/or amount of pain and opioid use after surgery. Veterans who are anxious or depressed before surgery will be randomly assigned to receive ACT plus TAU or TAU. Outcomes between the two groups will be compared. Aim 3 is to see if PROMIS modules, developed by the National Institute of Health, are useful for assessing pain and other symptoms in veterans. Findings from this study will be used to inform the design and implementation of a larger, well controlled, randomized clinical trial that will evaluate the efficacy of ACT plus TAU for at-risk veterans. This study will take place at the Iowa City VA Health Care System. Veterans scheduled for orthopedic surgery in 1 to 3 months who score high for anxiety or depression will be randomly assigned to attend a 1-day ACT workshop preoperatively, with an individualize “booster” session postoperatively, or to have TAU. Veterans who receive ACT and trainers who provide the treatment will be interviewed to identify barriers and facilitators to providing ACT to at-risk veterans before and after surgery. Other primary outcomes are pain and opioid use after surgery. Factors that may affect these outcomes will also be measured, including anxiety, depression, substance use disorder, post-traumatic stress disorder, and use of other pain meds. We expect to gain important knowledge about ways to best include ACT as part of routine care for veterans requiring surgery and about the preliminary efficacy of ACT for the prevention of persistent pain and prolonged opioid use following surgery.