Therapeutic IVR For Relapse Prevention in Chronic Pain

用于预防慢性疼痛复发的治疗性 IVR

• 批准号: 7663790
• 负责人: Magdalena R Naylor
• 金额: $ 31.04万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-12 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7663790
• 关键词: Absence of pain sensation; Accounting; Adverse effects; Aftercare; Alcohol or Other Drugs use; Analgesics; Attention; Award; Back Pain; Behavior Therapy; Behavioral; Cardiovascular Physiology; Chronic; Clinical Research; Clinical Trials Cooperative Group; Cognitive; Computers; Consent; Control Groups; Controlled Clinical Trials; Coping Skills; Data Analyses; Degenerative polyarthritis; Dependence; Doctor of Philosophy; Educational Intervention; Educational process of instructing; Epidemiology; Feedback; Funding; Goals; Grant; Group Therapy; Health Care Costs; Implantable Infusion Pumps; Individual; Intervention; Intervention Studies; Investigation; Low Back Pain; Maintenance; Medical; Medicare; Methods; Monitor; Musculoskeletal Diseases; Musculoskeletal Pain; Narcotic Analgesics; National Institute of Drug Abuse; Operative Surgical Procedures; Opioid; Outcome; Outcome Measure; Pain; Pain management; Patients; Persistent pain; Pilot Projects; Psychiatrist; Questionnaires; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Design; Research Personnel; SF-36; Sampling; Self Efficacy; Self Management; Spinal Cord; Spinal Fusion; Substance Use Disorder; Symptoms; System; Technology; Telephone; Testing; Therapeutic; Therapeutic Uses; Touch sensation; Training; Treatment Efficacy; United States National Institutes of Health; Upper Extremity; Upper arm; Vertebral column; Voice; Work; base; career; chronic pain; cognitive behavior therapy; comparative efficacy; comparison group; coping; cost effective; disability; disorder later incidence prevention; economic impact; effective therapy; efficacy testing; experience; follow-up; improved; middle age; non-cancer pain; novel; prescription drug abuse; prevent; proband; programs; psychologic; psychological distress; rehearsal; response; skills training; social; standard care; tool; treatment strategy

DESCRIPTION (provided by applicant): We propose to explore a well-known telephone-based technology (IVR) as a tool to reduce the pain, physical disability, and psychological distress experienced by patients with chronic musciiloskeletal pain. IVR (Interactive Voice Response) is a computer-based, automated telephone system that enables callers to respond to a recorded voice via the telephone keypad. Using this technology, we developed Therapeutic IVR (TIVR) as a tool for maintenance enhancement fallowing group cognitive-behavioral coping skills training (CST), a widely used behavioral treatment for chronic pain. The TFVR has four components: 1) an automated daily questionnaire for self monitoring, 2) a didactic review of coping skills, 3) guided behavioral rehearsals of CST coping skills, and 4) monthly feedback messages recorded on to the TIVR by the therapist. All four components can be accessed remotely by patients via any touch-tone phone. We initially tested the feasibility of the TIVR in a convenience pilot sample of 18 subjects. Ten patients with severe, chronic musculoskeletal pain participated in 11 weeks of group CST followed by four months of TIVR. A comparison sample of eight subjects received the same group CST by the same therapist, but not the TIVR. Both groups showed improvement after CST. However, between subjects analysis across the two groups showed that relevant outcome scores in the comparison sample worsened in the four months after CST whereas the same outcomes in the TIVR group improved during this period. In a second (ongoing) pilot study funded by a NIDA R21 grant, we are attempting to determine if the TIVR can be used to improve coping, decrease pain and reduce pain medication use. Study design and outcome measures are similar to those of the initial pilot study except that subjects are randomized. We have now analyzed data from 34 subjects, 15 probands and 19 controls. Preliminary results on the efficacy of the TIVR confirm the results of the initial pilot study. Between subjects analysis (ANCOVA) revealed statistically significant inter-group differences in: TOPS Pain Symptoms, TOPS Total Pain Experience, SF-36 Physical Composite, and CSQ Ability to Control Pain at both 4 and 8 months follow-up. The present R01 application is for a randomized controlled trial (RCT) of the TIVR in 150 patients with chronic musculoskeletal pain. We propose a 3-arm study. As before, all subjects will be given our standard 11 weeks of CST for pain coping skills. Consenting subjects will then be randomly assigned to one of three study conditions: 1) a no TIVR control condition (standard treatment); 2) an attention control condition, four months of calls to the Daily Self-monitoring Questionnaire with minimum monthly feedback; or 3) the full TIVR condition, four months of calls to the Full TIVR (all four components). The study goals are: 1) to attempt to replicate the results of the two pilot studies of TIVR in a full-scale RCT; and 2) to determine the efficacy of the full TIVR in relation to an attention control condition.

描述（由申请人提供）：我们建议探索众所周知的基于电话的技术（IVR），以减轻慢性肌肉骨骼疼痛患者所经历的疼痛，身体残疾和心理困扰的工具。 IVR（交互式语音响应）是一种基于计算机的自动电话系统，使呼叫者能够通过电话键盘响应记录的语音。使用这项技术，我们开发了治疗性IVR（TIVR）作为维持增强的软组织认知行为应对技巧培训（CST）的工具，这是一种广泛使用的行为治疗，用于慢性疼痛。 TFVR有四个组成部分：1）自动调查表进行自我监测，2）对应对技能的教学审查，3）CST应对技能的指导行为彩排，以及4）每月的反馈消息记录到治疗师的TIVR。所有四个组件都可以通过任何接触电话远程访问。 我们最初测试了TIVR在18个受试者的便利性试验样本中的可行性。十名患有严重的慢性肌肉骨骼疼痛的患者参加了CST组的11周，然后进行了四个月的TIVR。八名受试者的比较样本由同一治疗师接受了同一组CST，但没有接受TIVR。两组在CST后均显示出改善。但是，两组的受试者分析之间表明，在CST之后的四个月中，比较样本中的相关结果得分恶化，而在此期间，TIVR组的结果相同。在由NIDA R21赠款资助的第二次（正在进行的）试点研究中，我们试图确定是否可以使用TIVR来改善应对，减轻疼痛并减少止痛药的使用。研究设计和结果指标与初步研究的研究相似，但受试者是随机的。现在，我们已经分析了来自34名受试者，15个概率和19个对照的数据。关于TIVR的功效的初步结果证实了初步试点研究的结果。在受试者分析（ANCOVA）之间显示出统计学上显着的组间差异：顶部疼痛症状，TOPS总疼痛经验，SF-36物理复合材料以及CSQ在4个月和8个月的随访中控制疼痛的能力。 目前的R01应用是150例慢性肌肉骨骼疼痛患者的TIVR随机对照试验（RCT）。我们提出了一项三臂研究。和以前一样，所有受试者都将获得我们的标准CST 11周疼痛应对技巧。然后，同意受试者将随机分配到三个研究条件之一：1）无TIVR控制条件（标准治疗）； 2）注意力控制条件，对每日自我监控问卷进行了四个月的电话，每月反馈最少；或3）完整的TIVR条件，打电话给完整的TIVR四个月（所有四个组件）。研究目标是：1）试图在全尺度RCT中复制TIVR的两个初步研究的结果； 2）确定完整TIVR对注意力控制条件的疗效。