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: 10653361
• 负责人: Mark P Jensen
• 金额: $ 5.35万
• 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/10653361
• 关键词: Address; Adult; Affect; Aftercare; Algorithms; Behavior Therapy; Brain; Clinical Trials; Cognitive; Cognitive Therapy; Complementary Health; Conduct Clinical Trials; Data; Education; Effectiveness; Electroencephalography; Evidence based treatment; Foundations; Funding; Gold; Health; Health Personnel; Hypnosis; Individual; Integrative Medicine; Intervention; Knowledge; Measures; Mindfulness Training; Opioid Analgesics; Outcome; Pain; Pain Research; Pain intensity; Pain management; Parents; Participant; Patients; Pattern; Persons; Pharmacology; Predictive Factor; Public Health; Randomized; Research; Testing; Thinking; Treatment outcome; Veterans; Woman; base; chronic pain; chronic pain management; chronic pain patient; cognitive benefits; comparative efficacy; cost; design; effective therapy; hypnotic; individual response; men; mindfulness; mindfulness based cognitive therapy; pain catastrophizing; pain reduction; parent project; personalized care; predicting response; predictive marker; primary outcome; programs; psychosocial; response; 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. There is widespread recognition of the importance of developing effective complementary and integrative health (CIH) treatments and the need to optimize their effectiveness. The CIH pain treatment with the most empirical support is cognitive-behavioral therapy (CBT). However, not everyone benefits from CBT. Prior research has shown that two CIH interventions, Mindfulness-Based Cognitive Therapy (MBCT) and Hypnotic Cognitive Therapy (HYP-CT), are beneficial and offer alternatives to CBT and have similar efficacy. However, 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/opioid analgesic approaches. Finally, the study findings will be useful to health care providers and their patients to facilitate shared decision- making.

项目概要 慢性疼痛是一种普遍存在的致残问题，影响多达 50% 的男性退伍军人和 75% 的女性退伍军人。 人们普遍认识到发展有效的互补和整合的重要性 健康 (CIH) 治疗方法以及优化其有效性的必要性 CIH 疼痛治疗方法。 经验支持是认知行为疗法（CBT），但是，并不是每个人都能从 CBT 中受益。 研究表明，两种 CIH 干预措施：正念认知疗法 (MBCT) 和催眠疗法 认知疗法 (HYP-CT) 是有益的，可以替代 CBT，并且具有相似的功效。 与 CBT 一样，我们的初步数据表明，个体对这些治疗的反应也有很大差异。 治疗结果的差异可能是由于重要的基线患者差异造成的。 患者可以有效地“匹配”他们最有可能受益的治疗的可能性， 基于治疗开始前可以获得的信息，需要进行研究来开发患者。 治疗匹配算法最有可能将给定个体与基于证据的治疗相匹配 考虑到他们独特的个人特征，这项研究的总体目标是解决这个问题。 需要通过确定患者因素来确定谁从两种 CIH 治疗中受益最多，以及当前的治疗方案 相对于常规护理的黄金标准非药物治疗 (CBT) 这一目标将通过以下方法来实现。 我们将测试参与者将被随机分配到四种治疗条件之一的临床试验。 根据理论和先前的试点研究提出的假设，即预处理大脑活动模式， 催眠性、灾难性和适度的正念治疗前后疼痛的改善 在退伍军人中，相对于常规护理，与团体实施的 CBT、MBCT 和 HYP-CT 相关的强度 研究结果将为构建支持个性化护理的算法奠定基础， 因此，可以为退伍军人提供对他们最有益的治疗，这项研究也将有所帮助。 发展有关药物/阿片类镇痛方法的潜在有效替代方案的知识。 最后，研究结果将有助于医疗保健提供者及其患者促进共同决策- 制作。