Optimizing Response to Chronic Pain Treatments in Veterans: Identifying Key Moderators

优化退伍军人对慢性疼痛治疗的反应：确定关键调节因素

• 批准号: 10295409
• 负责人: Mark P Jensen
• 金额: $ 62.59万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10295409
• 关键词: Address; Affect; Aftercare; Algorithms; Analgesics; Behavior Therapy; Brain; Clinical Trials; Cognitive Therapy; Complementary Health; Data; Electroencephalography; Evidence based treatment; Foundations; Gold; Health Personnel; Individual; Integrative Medicine; Intervention; Knowledge; Measures; Outcome; Pain intensity; Pain management; Participant; Patients; Pattern; Persons; Pharmacology; Predictive Factor; Provider; Randomized; Research; Testing; Treatment outcome; Veterans; Woman; active method; base; chronic pain; chronic pain management; chronic pain patient; cognitive benefits; design; effective therapy; hypnotic; improved; individual patient; individual response; men; mindfulness; mindfulness based cognitive therapy; outcome prediction; pain catastrophizing; pain reduction; personalized care; precision medicine; predicting response; primary outcome; programs; prospective; prospective test; psychosocial; response; secondary analysis; secondary outcome; shared decision making; standard care; theories; trait; treatment as usual; treatment response

Project Summary Chronic pain is a prevalent, disabling problem affecting as many as 50% of men and 75% of women Veterans. The psychosocial pain treatment with the most empirical support is cognitive behavior therapy (CBT). However, not everyone benefits from CBT. Prior research has shown that two complementary and integrative health (CIH) interventions, Mindfulness-Based Cognitive Therapy (MBCT) and Hypnotic Cognitive Therapy (HYP-CT), are beneficial and offer alternatives to CBT and have similar efficacy. As with CBT, individual response to these treatments also varies considerably. Our preliminary data suggests the variability in treatment outcome may be due to important baseline patient differences. This suggests the possibility that patients can be effectively “matched” to the treatments they are most likely to benefit from, based on information that can be obtained before treatment starts. Research is needed to develop patient-treatment matching algorithms that could match a given individual to the evidence-based treatment most likely to be beneficial given their unique individual profile. The overall aim of the proposed study is to address this need by identifying patient factors that determine who benefits most from two CIH treatments and the current gold standard non-pharmacological treatment (CBT), relative to usual care. This aim will be addressed using a clinical trial in which participants will be randomized to one of the four treatment conditions. We will test hypotheses – developed from both theory and prior pilot research – that pre-treatment brain activity patterns, hypnotizability, catastrophizing, and mindfulness moderate pre- to post-treatment improvements in pain intensity associated with group-delivered CBT, MBCT, and HYP-CT, relative to usual care, in Veterans with chronic pain. The findings will provide the foundation for building an algorithm to support personalized care, whereby Veterans can be offered the treatment that will be most beneficial for them. This study will also help develop knowledge about potentially powerful alternatives to pharmacological analgesic approaches. Finally, the study findings will be useful to health care providers and their patients to facilitate shared decision-making.

项目摘要 慢性疼痛是一个普遍的，残疾的问题，影响了多达50％的男性和75％的女性退伍军人。 具有最经验支持的社会心理疼痛治疗是认知行为疗法（CBT）。 但是，并不是每个人都从CBT中受益。先前的研究表明，两个完整而整合 健康（CIH）干预措施，基于正念的认知疗法（MBCT）和催眠认知疗法 （HYP-CT）是有益的，并提供了CBT的替代方案，并且具有相似的效率。与CBT一样，个人 对这些治疗的反应也谨慎不同。我们的初步数据表明 治疗结果可能是由于重要的基线患者差异所致。这表明有可能 可以有效地将患者与他们最有可能受益的治疗方法“匹配” 可以在治疗开始之前获得的信息。需要研究以开发患者治疗 可以匹配的算法，这些算法可能与给定的个体与循证治疗相匹配 鉴于其独特的个人资料，有益。拟议研究的总体目的是通过 确定确定谁从两种CIH治疗和当前黄金中受益最大的患者因素 相对于通常的护理，标准的非药物治疗（CBT）。这个目标将使用 临床试验，其中参与者将被随机分为四个治疗条件之一。我们将测试 假设是从理论和先前的试点研究中发展出来的 - 治疗预处理大脑活动模式， 催眠性，灾难性和正念适中疼痛后治疗后的改善 与常规护理相对于经常护理，与群体交付的CBT，MBCT和HYP-CT相关的强度 慢性疼痛。这些发现将为建立算法以支持个性化护理的基础， 可以为退伍军人提供对他们最有益的待遇。这项研究也将有所帮助 发展有关药物镇痛方法的潜在强大替代方案的知识。最后， 研究结果将对医疗保健提供者及其患者有用，以促进共同的决策。