Telephone Cognitive Behavior Therapy for OEF Veterans with Pain

描述（由申请人提供）： 虽然有越来越多的经验证据表明，旨在提高应对技能的认知行为疗法对慢性疼痛患者有益，但这些干预措施的使用往往有限。慢性疼痛在OEF/OIF退伍军人中非常普遍。本研究的主要目的是测试电话传递的认知行为疗法在慢性疼痛退伍军人中的有效性。第二个目的是确定这种干预措施促进疼痛管理和OEF/OIF退伍军人对慢性疼痛的成功调整的机制。主要的假设是，与接受电话疼痛教育的患者相比，接受电话认知行为治疗的患者在疼痛相关的应对技能方面会有显着改善，情绪困扰减少，生活质量提高。为了实现这些目标，将在150名慢性疼痛患者中开展一项双臂随机临床试验，这些患者是从位于San弗朗西斯科的VA医疗中心的初级保健诊所和位于圣布鲁诺、圣罗莎、尤基亚和尤里卡的附属VA社区门诊招募的。将邀请目前入组的患有涉及肌肉拉伤和炎症、神经创伤或中枢神经系统功能障碍的疼痛疾病的患者参加。在研究组1中，患者将接受电话传递的认知行为治疗（T-CBT）;在研究组2中，患者将接受与研究组1相匹配的电话传递的疼痛教育（T-EDU），其接触时间。两组患者将在20周内接受12次电话个体化治疗。将在第10周（治疗中期）、第20周（治疗后）、第32周（3个月随访）和第46周（6个月随访）时测量疼痛管理结局。结果变量将包括疼痛症状，功能水平，应对和情绪困扰的措施。样本量将提供大于80%的把握度来检测组间显著差异，双尾α为0.05。研究假设、评估方法和干预程序均基于慢性疼痛的认知-行为模型。

DESCRIPTION (provided by applicant): Although there is growing empirical evidence that cognitive behavior therapy aimed at improving coping skills is beneficial for individuals who suffer from chronic pain, access to these interventions is often limited. Chronic pain is highly prevalent in OEF/OIF veterans. The primary aim of this study will be to test the effectiveness of telephone- delivered cognitive-behavior therapy in the management of chronic pain among post- deployment veterans with chronic pain. A secondary aim will be to determine mechanisms by which this intervention facilitates pain management and successful adjustment of OEF/OIF veterans to chronic pain. The major hypothesis is that patients who receive telephone-delivered cognitive-behavior therapy will show significant improvements in pain-related coping skills, reduced emotional distress, and increased quality of life compared with those who receive telephone-delivered pain education. To achieve these aims, a two-arm randomized clinical trial will be conducted with 150 individuals who suffer from chronic pain, recruited from primary care clinics at the VA Medical Center in San Francisco and affiliated VA Community-based Outpatient Clinics in San Bruno, Santa Rosa, Ukiah, and Eureka. Currently enrolled patients with pain disorders involving muscle strain and inflammation, trauma to nerves, or central nervous system dysfunction will be invited to participate. In Study Arm 1, patients will receive telephone-delivered cognitive behavior therapy (T-CBT); and in Study Arm 2, patients will receive telephone-delivered pain education (T-EDU) matched with Study Arm 1 for amount of contact time. Patients in both groups will receive 12 sessions of telephone- delivered individual therapy over a 20-week period. Pain management outcomes will be measured at 10 weeks (mid-treatment), 20 weeks (post-treatment), 32 weeks (3-month follow-up), and 46 weeks (6-month follow-up). Outcome variables will include measures of pain symptoms, level of functioning, coping, and emotional distress. The sample size will provide greater than 80% power to detect significant differences between groups, at a two-tailed alpha of 0.05. The study hypothesis, assessment methodology, and intervention procedures are based on the cognitive-behavioral model of chronic pain.