Home-Based Self-Management of Chronic Pain in Adults with Sickle Cell Disease: Applying a Biopsychosocial and Technological Approach

项目总结/摘要。在患有镰状细胞病（SCD）的成人中，慢性疼痛与以下因素有关： 显著的发病率、死亡率和医疗保健利用率。SCD中慢性疼痛的发生率很高， 可能会随着受影响的个体过渡到年轻的成年期而增加。然而，患有SCD的黑人成年人 在获得包括行为疼痛在内的慢性疼痛的全面护理方面经常遇到挑战 管理战略。因此，慢性疼痛通常用阿片类药物治疗，但单独使用阿片类药物往往 次优，与不良的健康结果有关，其使用受到限制， 目前美国的阿片类药物流行病。因此，替代性、循证、非药理学 需要选择解决慢性疼痛的心理社会方面，并支持疼痛自我管理， 家庭环境，以减轻SCD的负担，提高受影响个体的生活质量。 虚拟现实（VR）是一种及时和创新的工具，可以减少疼痛， 经历慢性疼痛状况，如复杂的区域疼痛综合征，纤维肌痛和慢性疼痛。 偏头痛虽然VR应用通常用于诊所或医院环境，主要用于急性疼痛， 成本降低和技术进步为其在国内长期使用创造了潜力。在 此外，移动的和游戏技术在年轻人中的普及表明，VR是一种有前途的 交付平台。因此，VR可用于实施基于家庭的慢性疼痛自我管理， 成人SCD到目前为止，还没有发表关于VR干预慢性疼痛的研究。 在家庭环境中对成人SCD进行管理。该项目将评估EaseVRx - a 多模式，基于技能，8周，VR，家庭干预-在一项探索性试验中， 60名患有SCD的黑人年轻人（年龄18-40岁）的慢性疼痛。EaseVRx体验基于 疼痛教育、疼痛心理学、生物反馈相关的循证疼痛管理方法 训练，放松，分散注意力类似于个人综合疼痛管理计划，EaseVRx 提供治疗信息，以支持参与者学习认知和行为自我管理 技能和重新训练疼痛通路。一项单中心、混合方法、探索性、平行组、随机 将在成人SCD患者中进行EaseVRx与活性对照的对照试验（RCT），以：1） 确定使用EaseVRx进行慢性疼痛自我管理的可行性; 2）评估初步 EaseVRx对疼痛和疼痛相关结局的疗效;以及3）评估EaseVRx如何针对 目标受众主要是黑人。将从电子病历中获取数据， 经过验证的调查、疼痛日记、设备使用统计和定性个人访谈或焦点小组 sessions.该项目符合国家核研究所的优先事项。研究结果将用于开发和测试 在一项更大规模的随机对照试验中，为成人SCD患者提供量身定制的、以家庭为基础的疼痛自我管理干预。

PROJECT SUMMARY/ABSTRACT. In adults with sickle cell disease (SCD), chronic pain is associated with substantial morbidity, mortality, and healthcare utilization. The incidence of chronic pain in SCD is high and is likely to increase as affected individuals transition through young adulthood. However, Black adults with SCD often encounter challenges in obtaining comprehensive care for chronic pain that includes behavioral pain management strategies. As a result, chronic pain is typically managed with opioids but opioids alone are often suboptimal, are associated with poor health outcomes, and their use is limited by access restrictions due to the current opioid epidemic in the United States. Therefore, alternative, evidence-based, non-pharmacological options are needed to address the psychosocial aspects of chronic pain and support pain self-management in the home setting in order to decrease the burden of SCD and improve the quality of life of affected individuals. Virtual reality (VR) is a timely and innovative tool that has resulted in pain reduction for individuals who experience chronic pain conditions, such as complex regional pain syndrome, fibromyalgia, and chronic migraines. While VR applications have typically been used in a clinic or hospital setting primarily for acute pain, cost reductions and advances in the technology have created the potential for its long-term use at home. In addition, the popularity of mobile and gaming technology among young adults suggests that VR is a promising delivery platform. Therefore, VR may be utilized to implement home-based chronic pain self-management for adults with SCD. To date, there have been no published studies of VR interventions for chronic pain management in the home setting for adults with SCD. This project will evaluate AppliedVR's EaseVRx – a multi-modal, skills-based, 8-week, VR, home intervention – in an exploratory trial for self-management of chronic pain among 60 Black, young adults (ages 18–40) with SCD. EaseVRx experiences are based on evidence-based pain management approaches related to pain education, pain psychology, biofeedback training, relaxation, and distraction. Similar to in-person integrative pain management programs, EaseVRx provides therapeutic information to support participants in learning cognitive and behavior self-management skills, and retraining the pain pathways. A single-site, mixed-methods, exploratory, parallel-group randomized controlled trial (RCT), of EaseVRx versus active control, among adults with SCD will be conducted to: 1) determine the feasibility of using EaseVRx for self-management of chronic pain; 2) assess the preliminary efficacy of EaseVRx on pain and pain-related outcomes; and 3) assess how EaseVRx can be tailored for a target audience that mostly consists of Black individuals. Data will be obtained from electronic medical records, validated surveys, a pain dairy, device usage statistics, and qualitative individual interviews or focus group sessions. This project aligns with the priorities of NINR. Study findings will be used to develop and test a tailored, home-based, pain self-management intervention for adults with SCD in a larger RCT.