PATINA: Pain Management Training in Native American Communities

描述（由申请人提供）：疼痛是人们寻求医疗护理的主要原因。不幸的是，疼痛治疗不足在癌症（Cohen et al., 2003; Deandrea et al., 2008）和其他疾病（Boulanger et al., 2007; Hadjistavropoulos et al., 2006）中有充分的记录。虽然药物仍然是对抗疼痛的第一道防线，但对认知行为疼痛管理（CBPM）技术有效性的经验支持仍在不断增长。CBPM技术，如横膈膜呼吸、渐进式肌肉放松和引导成像，单独使用或与药物治疗相结合，已被证明可以显着减少癌症和非癌症相关的疼痛。然而，目前，缺乏文化适应和提供者培训是更广泛使用这些治疗的障碍，特别是在治疗美洲印第安人（AIs）和阿拉斯加原住民（ANs）的农村和部落诊所。研究表明，文化适宜性对少数民族患者的认知行为干预的可接受性很重要。因此，这一快速通道申请建议创建一种互联网交付的、文化定制的多媒体培训，向服务于农村社区和人工智能/人工智能网络的提供者教授经验支持的CBPM技术，以便这些提供者反过来可以向患者教授这些技术。拟议的产品PATINA（美洲土著社区疼痛管理培训）在其基于网络和互联网的培训CBPM技术方法、其文化特殊性以及在农村医院和部落诊所环境中使用远程保健进行形成性和评价性研究方面具有创新性。主要客户将是农村医疗保健提供者和治疗AI/AN患者的人员。完成培训的继续教育单位将获得奖励。结合了书籍和课程的优点，基于网络的培训成本低，方便，并提供互动性，反馈和实践机会。

DESCRIPTION (provided by applicant): Pain is the primary reason that people seek medical care. Unfortunately, under-treatment of pain is well- documented in cancer (Cohen et al, 2003; Deandrea et al., 2008) and other medical conditions (Boulanger et al., 2007; Hadjistavropoulos et al., 2006). While medication continues to be the first line of defense against pain, empirical support for the effectiveness of cognitive-behavioral pain management (CBPM) techniques continues to grow. Used alone or in conjunction with pharmacological treatment, CBPM techniques such as diaphragmatic breathing, progressive muscle relaxation, and guided imagery have been shown to significantly reduce both cancer- and non-cancer-related pain. Currently, however, a lack of cultural adaptation and provider training are barriers to the more wide-spread use of these treatments, especially in rural and tribal clinics that treat American Indians (AIs) and Alaska Natives (ANs). Research indicates that cultural appropriateness is important to the acceptability of cognitive behavioral interventions vis-a-vis minority patients. Therefore, this Fast-Track application proposes to create an internet-delivered, culturally- tailored multimedia training to teach empirically-supported CBPM techniques to providers serving rural communities and AI/ANs, so that these providers, in turn, can teach these techniques to their patients. The proposed product, PATINA (Pain Management Training in Native American Communities), is innovative in its web- and internet-based approach to training CBPM techniques, in its cultural specificity, and in its use of telehealth to conduct formative and evaluative research in rural hospital and tribal clinic settings. Primary customers will be rural healthcare providers and those treating AI/AN patients. Continuing education units will be awarded for completing the training. Combining the best features of books and classes, web-based training is low cost, convenient, and offers interactivity, feedback and practice opportunities. PUBLIC HEALTH RELEVANCE: Cognitive-behavioral pain management (CBPM) techniques are strongly endorsed by several national organizations as an important component of a comprehensive pain management approach. However, lack of access to provider training is a major barrier to their more wide-spread use, especially in rural areas and clinics that serve American Indians and Alaska Natives. This proposal seeks to improve public health by creating an internet-delivered, culturally-tailored multimedia training to teach CBPM techniques to providers serving rural areas and American Indians and Alaska Natives, so that these providers can teach these techniques to their patients.