PREventing Pain after Surgery: A feasibility and acceptability study of Acceptance and Commitment Therapy for the prevention of chronic post surgical pain (PREPS)

项目总结/摘要 每年有超过10%的美国人口因脊柱疼痛而寻求护理， 崛起腰椎手术最具挑战性但最常见的后遗症之一是慢性术后 疼痛（CPSP）。CPSP与身体功能差有关，仍然难以治疗。 经常使用阿片类药物治疗，尽管有证据表明长期使用阿片类药物治疗 慢性疼痛可能无效，并可能增加过量相关死亡的风险。因此，需要 防止从急性到慢性手术后疼痛的转变是很大的，特别是对于接受手术的患者， 腰椎手术接受和承诺疗法（ACT）是一种心理社会干预， 有效改善慢性疼痛患者的身体功能和生活质量 治疗阿片类药物使用障碍。因此，有理由认为，共助疗法可能是预防艾滋病毒/艾滋病的一个有希望的工具。 CPSP和长期使用阿片类药物。它还被修改成简短的格式，以提高遵守率， 最大限度地减少治疗障碍，如费用和获取。本研究的目的是适应和修改一个简短的 术前ACT干预旨在防止过渡到CPSP并减少长期阿片类药物使用。 然后，我们将评估最终干预措施的可接受性、可行性和初步疗效， 防止过渡到CPSP，并减少腰椎手术后6个月的术后阿片类药物使用。 最后，我们将确定与此相关的心理社会和心理物理表型 干预总之，这项研究将使我有机会获得治疗开发方面的培训 临床试验的实施、开发和执行，同时推进我的长期目标， 开发基于机制的非药物干预措施，以预防CPSP的发展， 降低长期使用阿片类药物的风险。

Project Summary/Abstract More than 10% of the U.S. population seeks care for spine pain each year with rates of surgical procedures on the rise. One of the most challenging yet common sequelae of lumbar spine surgery is chronic post-surgical pain (CPSP). CPSP is associated with poor physical function and remains difficult to treat. Indeed, it is frequently treated with opioid medications, despite evidence that long term opioid use for the treatment of chronic pain may not be effective and may increase the risk of overdose-related death. Therefore, the need to prevent the transition from acute to chronic post-surgical pain is great, especially for patients undergoing lumbar spine surgery. Acceptance and Commitment Therapy (ACT) is a psychosocial intervention that has been effective in improving physical function and quality of life among patients with chronic pain as well treating opioid use disorders. Thus, it stands to reason that ACT may be a promising tool for the prevention of CPSP and long-term opioid use. It has also been modified into brief formats in order increase adherence and minimize treatment barriers such as cost and access. The present study aims to adapt and modify a brief presurgical ACT intervention aimed at preventing the transition to CPSP and reducing long-term opioid use. We will then assess the acceptability, feasibility, and preliminary efficacy of the finalized intervention to prevent the transition to CPSP and reduce post-surgical opioid use six months following lumbar spine surgery. Finally, we will identify psychosocial and psychophysical phenotypes associated with response to this intervention. Together, this study will afford me the opportunity to gain training in treatment development and implementation and development and execution of clinical trial while advancing my long-term goal of developing mechanistically-based nonpharmacologic interventions to prevent the development of CPSP and reduce the risk of long-term opioid use.