Acceptance and commitment therapy to address the psychosocial co-morbidities of chronic pain in aging people living with HIV

接受和承诺疗法可解决老年艾滋病毒感染者慢性疼痛的心理社会并发症

• 批准号: 9762827
• 负责人: Maile Ann Young Karris
• 金额: $ 11.81万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9762827
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adverse effects; Affect; Age; Aging; Alcohol or Other Drugs use; Behavior; Case Manager; Clinic; Cognitive Therapy; Cognitive deficits; Communities; Comorbidity; Dangerousness; Data; Degenerative polyarthritis; Delirium; Development; Development Plans; Disease; Education; Elderly; Emotional; Emotions; Evaluation; Exhibits; Feedback; Focus Groups; Future; Gastrointestinal Hemorrhage; Goals; Grant; HIV; HIV Seronegativity; HIV therapy; Health; Health Educators; High Prevalence; Human Resources; Impaired cognition; Impairment; Injecting drug user; Intervention; Investments; Life; Life Experience; Literature; Loneliness; Medical; Mental Depression; Methods; Modeling; Muscle relaxants; Non-Steroidal Anti-Inflammatory Agents; Outcome; Pain; Pain management; Participant; Patient Self-Report; Performance; Peripheral Nervous System; Persons; Pharmaceutical Preparations; Physical Function; Physical Performance; Population; Professional counselor; Psychosocial Factor; Psychotherapy; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Research; Risk; Severities; Skeletal Muscle; Social isolation; Stress; Substance abuse problem; Therapeutic Intervention; Thinking; Toxic effect; Training; Trauma; Treatment Efficacy; Treatment outcome; Uncontrolled Study; antiretroviral therapy; career; chronic pain; coping; experience; fall risk; falls; gender minority; health disparity; improved; mental state; mortality; negative affect; neurotoxicity; non-cancer chronic pain; novel; opioid misuse; opioid overdose; pain relief; pain symptom; prescription opioid misuse; primary outcome; programs; psychologic; psychosocial; racial minority; randomized trial; response; satisfaction; scale up; side effect; skills training; social stigma; socioeconomic disadvantage; treatment disparity

PROJECT SUMMARY/ABSTRACT Chronic pain affects a very high proportion of aging people living with HIV (aPLWH) and is thought to be related to both direct toxicity of HIV and antiretroviral therapy (ART) and by psychosocial factors that negatively affect pain (i.e. loneliness, HIV stigma). PLWH are also at increased risk for prescription opiate misuse. However as PLWH age, non-opiate medications used for pain can contribute to other negative outcomes such as falls, altered mental status and gastrointestinal bleeding. Thus there is a critical need for the development of novel interventions in the management of chronic pain in aPLWH that consider the psychological co- morbidities of aging with HIV and that can minimize the need for prescription medications. Acceptance and commitment therapy (ACT) has previously been evaluated in older persons with chronic pain and has demonstrated higher levels of satisfaction and efficacy when compared to cognitive behavioral therapy (CBT). ACT has never been evaluated in aPLWH for chronic pain, but has theoretical advantages over CBT for this population. Specifically several negatively modifying factors of CBT efficacy such as cognitive deficits are common in aPLWH. The overarching objective of this study is to determine the acceptability and feasibility of an ACT intervention for the management of chronic pain adapted to aPLWH. To accomplish this objective I will 1) train lay personnel to perform ACT to determine feasibility of this approach for future implementation, 2) conduct uncontrolled group ACT in aPLWH to generate participant feedback and questionnaire data to inform ACT adaption with the assistance of a steering commitee, and 3) conduct a pilot randomized controlled trial (RCT) evaluating the acceptability of adapted ACT compared to pain education. At completion of this grant we expect to have successfully trained lay personnel to perform group ACT, adapted ACT from quantitative and qualitative data collected from an uncontrolled study of group ACT, and determined whether ACT is acceptable and feasible as an intervention in aPLWH. These expected outcomes may benefit other aging populations with chronic pain that are enriched for psychosocial co-morbidities such as persons who inject drugs, the socioeconomically disadvantaged, and racial or gender minorities. This proposal is aligned with the Office of AIDS Research High Priorities to better understand “HIV-associated comorbidities” which includes pain and to “Reduce Health Disparities in treatment outcomes of those living with HIV/AIDS” and with the National Pain Strategy to “expand investment … in the development of safe and effective pain treatments.”

项目摘要/摘要 慢性疼痛会影响艾滋病毒（APLWH）的老年人比例很高，被认为是 与艾滋病毒和抗逆转录病毒疗法（ART）的直接毒性以及对否定性的心理社会因素有关 影响疼痛（即孤独，艾滋病毒污名）。 PLWH的处方风险也增加了，优化了MISSUSE。 但是，作为PLWH的年龄，用于疼痛的非锻炼药物可能会导致其他负面结果 随着瀑布的变化，精神状态和胃肠道出血。对于发展的迫切需要 在APLWH中管理慢性疼痛的新干预措施，这些干预考虑了心理学共同 艾滋病毒衰老的病态性，这可以最大程度地减少处方药的需求。接受和 承诺疗法（ACT）以前已经在患有慢性疼痛的老年人中进行了评估，并且 与认知行为疗法（CBT）相比，表现出更高的满意度和效率。 ACT从未在APLWH中评估过慢性疼痛，但对CBT具有理论优势 人口。特别是CBT轻松的几个负面修改因素，例如认知缺陷 在aplwh中常见。这项研究的总体目的是确定 适应APLWH的慢性疼痛的管理干预措施。为了实现这一目标，我将 1）训练外行人员执行ACT以确定这种方法的可行性，以将来实施，2） 在APLWH中进行不受控制的小组法，以产生参与者的反馈和问卷数据以告知 在转向委员会的协助下，ACT适应，3）进行试点随机对照试验 （RCT）与疼痛教育相比，评估适应性行为的可接受性。完成这笔赠款后，我们 期望成功培训的外行人员执行团体法，从定量和 从不受控制的小组法研究中收集的定性数据，并确定ACT是否可以接受 并且可以作为干预APLWH的可行。这些预期的结果可能会使其他老龄化的人口受益 慢性疼痛富含心理社会的合并症，例如注射药物的人， 在社会经济上处于不利地位，种族或性别少数群体。该建议与 AIDS研究高度优先事项，以更好地了解“与HIV相关的合并症”，其中包括疼痛和 “减少艾滋病毒/艾滋病患者的治疗结果中的健康差异”和民族痛苦 “扩大投资……在开发安全有效的疼痛治疗方面的策略”。

项目成果

Successful optimization of antiretroviral regimens in treatment-experienced people living with HIV undergoing liver transplantation.

在经历过治疗且接受肝移植的艾滋病毒感染者中成功优化抗逆转录病毒治疗方案。

• DOI: 10.1111/tid.13174
• 发表时间: 2019
• 期刊: Transplant infectious disease : an official journal of the Transplantation Society
• 作者: Waldman,Georgina;Rawlings,StephenA;Kerr,Janice;Vodkin,Irine;Aslam,Saima;Logan,Cathy;Dan,Jennifer;Mehta,Sanjay;Hill,Lucas;Karris,MaileY
• 通讯作者: Karris,MaileY