Development of a Personalized Feedback Intervention Targeting Pain-Related Anxiety for Hazardous Drinkers with Chronic Pain

项目总结/摘要 危险的酒精使用会导致精神和身体健康问题，残疾，并可能导致 过早死亡的风险增加3，4.在慢性疼痛患者中，危险酒精使用率为 与一般人群相比，5升高，然而，患有慢性疼痛的危险酒精使用者仍然是一个 服务不足的群体迫切需要测试替代和补充办法， 实施有效干预措施，减少这一高风险群体的危险酒精使用 一般人群;以综合的方式这样做（即，联合针对酒精和情感机制 可以维持疼痛-酒精关联）可以提供更有效和有针对性的干预方法。 针对疼痛相关焦虑，一种与两者前瞻性相关的跨诊断脆弱性因素 危险的饮酒和慢性疼痛6，7，可能是有益的。因此，需要做更多的工作来评估 在患有慢性疼痛的危险饮酒者中，针对疼痛相关焦虑升高的益处。我们 方法将遵循与NIH指导方针一致的阶段模型，用于开发和标准化行为 干预措施。IA期活动将涉及从迭代焦点小组（N = 10）收集定性反馈 细化干预内容，评估治疗的可接受性和可行性。IB阶段活动将包括 一项概念验证和高度严格的随机临床试验，旨在比较疼痛相关的 焦虑/酒精PFI（PA-PFI）与对照PFI（C-PFI）在130例慢性酒精中毒危险饮酒者中的比较 疼痛相关焦虑水平升高的患者。这项研究是一个重要的和关键的一步， 将基础研究转化为更有效的战略， 有医疗共病的弱势人群中饮酒。拟议的干预措施将是 这是一个高度可传播的，与数百万患有慢性疼痛的危险饮酒者相关的信息。鉴于公众的集体 慢性疼痛和危险饮酒对健康的影响，拟议的研究将产生的结果， 科学知识，增强我们对相互疼痛-酒精关系机制的理解， 为患有慢性疼痛的危险饮酒者提供新的治疗方法， 焦虑，适应性强，易于在各种医疗保健环境中实施。

Project Summary/Abstract Hazardous alcohol use contributes to mental and physical health problems, disability, and may lead to increased risk of premature death3,4. Among individuals with chronic pain the rate of hazardous alcohol use is elevated compared to the general population5, yet, hazardous alcohol users with chronic pain remain an underserved group. There is a critical need to test alternative and complimentary approaches to the implementation of effective interventions to reduce hazardous alcohol use among this high-risk segment of the general population; doing so in an integrated fashion (i.e., jointly targeting alcohol and affective mechanisms that may maintain pain-alcohol associations) may provide a more efficient and targeted intervention approach. Targeting pain-related anxiety, a transdiagnostic vulnerability factor that is prospectively associated with both hazardous drinking and chronic pain6,7, may be beneficial. Thus, more work is needed to evaluate the benefit of targeting elevated pain-related anxiety among hazardous drinkers with chronic pain. Our approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral interventions. Phase IA activities will involve collecting qualitative feedback from iterative focus groups (N = 10) to refine intervention content and evaluate treatment acceptability and feasibility. Phase IB activities will include a proof-of-concept and highly rigorous randomized clinical trial designed to compare pain-related anxiety/alcohol PFI (PA-PFI) to control PFI (C-PFI) among a sample of 130 hazardous drinkers with chronic pain who have elevated levels of pain-related anxiety. This study represents an important and pivotal step in the larger landscape of translating basic research to more efficacious strategies for reducing hazardous drinking among underserved populations with medical comorbidities. The proposed intervention would be highly disseminable and relevant to millions of hazardous drinkers with chronic pain. Given the collective public health impact of chronic pain and hazardous drinking, the proposed study will yield findings that enhance scientific knowledge, enhance our understanding of mechanisms in reciprocal pain-alcohol relations, and inform the development of novel treatments for hazardous drinkers with chronic pain with elevated pain-related anxiety that are adaptable and easily implemented across a variety of healthcare settings.