The Effects of Vocal Music Therapy on Core Outcomes in Chronic Pain Management: A

描述（由申请人提供）：每年花费数十亿美元用于传统疼痛治疗，但慢性疼痛的充分管理仍然是一个挑战。患有慢性疼痛的人，通常在对传统干预措施感到失望之后，越来越多地寻求补充性疼痛治疗。在过去的二十年里，音乐作为一种非药物性疼痛治疗方法越来越受到人们的关注。不幸的是，关于使用音乐进行疼痛管理的研究主要集中在听预先录制的音乐上。虽然听音乐确实可以作为一种分心物或放松剂，但临床经验表明，患者积极参与音乐治疗可以增加有效疼痛管理的成分。具体而言，我们开发了一种声乐疗法（VMT）治疗计划，该计划激活了对改善慢性疼痛管理需求患者的身体和情感功能以及自我效能至关重要的机制。这些机制包括增强身体意识、准备与身体合作而不是对抗身体、增加接受度、改善情感表达能力、增强情绪、增加快乐和活力以及增强社会支持。我们的8周VMT治疗计划使用临床测试的技术，包括音调（拉长元音的歌唱），集体歌唱和深呼吸。这项探索性研究的目的是测试VMT对慢性疼痛患者的可行性、接受程度和治疗效果。采用等待名单对照组设计，我们将48名患有慢性疼痛的市中心成年人随机分为VMT治疗组或标准护理等待名单对照组（WLC）。我们将：1）评价VMT与标准治疗相比对作为主要结局的身体功能和自我效能、疼痛强度、疼痛应对、情绪功能、患者感知的影响大小 的变化，医疗消费作为第二个结果。将在基线、4周、8周和1个月随访时进行结局测量; 2）评价VMT治疗方案的可行性和可接受性，以及WLC组设计; 3）在1个月随访期间通过焦点小组获得参与者对治疗方案的定性反馈和感知获益。本研究的结果将用于支持未来全规模随机对照试验的设计决策。如果这项拟议的试点研究的结果是积极的，并在更大的试验中复制，VMT可能成为一个有吸引力的，具有成本效益的连续治疗选择，没有副作用或并发症。此外，人口群体，如非洲裔美国人和拉丁美洲人，对他们来说，社区音乐制作是他们文化的一个组成部分，可能会将VMT视为他们慢性疼痛管理需求的理想补充治疗选择。 慢性疼痛影响超过35%的美国人口，估计医疗费用为4130亿美元。由于传统的疼痛治疗往往无法带来足够的疼痛缓解，慢性疼痛患者越来越多地寻求补充疼痛治疗。这项研究将测试声乐治疗计划的可行性和效果，该计划是专门为改善慢性疼痛患者的身体和情感功能以及自我效能而开发的。

DESCRIPTION (provided by applicant): Billions of dollars are spent annually on traditional pain treatments, but adequate management of chronic pain continues to present a challenge. People with chronic pain, often after being disillusioned by traditional interventions, increasingl seek complementary pain treatments. The use of music as a non-pharmacological pain treatment has received growing attention during the past two decades. Unfortunately, research on the use of music for pain management has focused primarily on listening to pre-recorded music. While it is true that listening to music can function as a distractor or a relaxing agent, or clinical experience indicates that patients' active engagement in music therapy enlists added components of effective pain management. Specifically, we have developed a vocal music therapy (VMT) treatment program that activates mechanisms important for im- proved physical and emotional functioning and self-efficacy for people with chronic pain management needs. These mechanisms include augmented body awareness, readiness to work with the body rather than against it, increased acceptance, improved emotional expressivity, enhanced mood, increased joy and energy, and enhanced social support. Our 8-week VMT treatment program uses clinically tested techniques including ton- ing (singing of elongated vowels), group singing, and deep breathing. The purpose of this exploratory study is to test the feasibility, acceptance, and treatment effects of VMT with people who experience chronic pain. Us- ing a wait-list control group design, we will randomize 48 inner-city adults with chronic pain to the VMT treat- ment group or the standard care wait-list control (WLC) group. We will: 1) evaluate the size of the effects of VMT, compared with standard care, on physical functioning as the primary outcome and self-efficacy, pain in- tensity, pain coping, emotional functioning, patient perception of change, and healthcare consumption as sec- ondary outcomes. Outcome measures will be administered at baseline, 4 weeks, 8 weeks, and one-month fol- low-up; 2) evaluate the feasibility and acceptance of the VMT treatment program, as well as the WLC group design; and 3) obtain qualitative participant feedback on the treatment protocol and perceived benefits through a focus group during the one-month follow-up session. The results from this study will be used to support de- sign decisions for a future full-scale randomized controlled trial. If the findings of this proposed pilot study are positive and are replicated in larger trials, VMT could become an attractive, cost-effective adjunctive treatment option with no side-effects or complications. Furthermore, population groups, such as African-Americans and Latinos, for whom community music making is an integral part of their culture may view VMT as a desirable complementary treatment option for their chronic pain management needs. PUBLIC HEALTH RELEVANCE: Chronic pain affects more than 35% of the U.S. population and carries an estimated healthcare expense of $413 billion. Because traditional pain treatments often fail to bring adequate pain relief, people with chronic pain increasingly seek complementary pain treatments. This study will test the feasibility and effects of a vocal music therapy treatment program that was developed specifically to improve the physical and emotional functioning and self-efficacy of people with chronic pain.