Efficacy of Telephone-Delivered Cognitive Behavioral Therapy for Chronic Pain

电话认知行为疗法治疗慢性疼痛的疗效

• 批准号: 8115728
• 负责人: DAWN M. EHDE
• 金额: $ 20.94万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-08 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8115728
• 关键词: Address; Adult; Aftercare; Amputation; Attention; Behavioral; Belief; Chronic disabling pain; Clinical Trials; Cognition; Cognitive; Cognitive Therapy; Coping Behavior; Disabled Persons; Dose; Education; Educational Intervention; Functional disorder; High Prevalence; Instruction; Intervention; Literature; Mediating; Motivation; Multiple Sclerosis; Outcome; Outcome Measure; Pain; Pain management; Participant; Persons; Physical Function; Quality of life; Randomized; Randomized Clinical Trials; Relative (related person); Research; Sampling; Scientific Advances and Accomplishments; Secondary to; Self Efficacy; Signal Transduction; Site; Spinal cord injury; Telephone; Testing; Therapeutic; Therapeutic Effect; Thinking; Time; base; biopsychosocial; chronic pain; cost; demographics; design; disability; effective therapy; experience; improved; improved functioning; intervention effect; psychologic; public health relevance; satisfaction; secondary outcome; treatment adherence

DESCRIPTION (provided by applicant): The overall objective of the study is to increase our understanding of whether and how a cognitive therapy intervention reduces pain and pain-related dysfunction in persons with chronic pain secondary to a disability. Specifically, the project will: (1) evaluate the efficacy of a telephone-delivered cognitive therapy intervention for pain in a sample of adults with chronic pain and acquired amputation, multiple sclerosis, or spinal cord injury via a randomized clinical trial; and (2) study the potential mechanisms of the effects of cognitive therapy by determining whether treatment-related changes in cognitions (specifically catastrophizing cognitions and control beliefs) mediate the effects of the intervention on pain. These aims will be accomplished by randomly assigning persons with disabilities and chronic pain (N = 160) to one of two conditions. In the first condition, the telephone-delivered cognitive therapy condition, participants will received cognitive therapy specifically instructing them in cognitive strategies (e.g., recognition of maladaptive thinking, cognitive restructuring, thought stopping) targeting pain catastrophizing, control beliefs, and other negative thoughts about pain. The intervention will be provided over the telephone to mitigate access barriers to treatment faced by many persons with pain and disability. The second condition will be a telephone-delivered pain education condition in which participants will receive education about chronic pain, but no instruction in cognitive or behavioral pain management strategies; the second condition will thus serve as an attention control condition. If the study hypotheses are supported, and the telephone-delivered cognitive therapy condition is shown to be efficacious in reducing pain and improving functioning relative to the education condition, the intervention used in this proposal will serve as a basis for a telephone-delivered treatment that could stand alone or be incorporated into interdisciplinary biopsychosocial interventions for pain in persons with disabilities. These findings will also advance the field of pain treatments by furthering our theoretical understanding of hypothesized, but rarely tested, mechanisms thought to underlie the efficacy of cognitive therapy for chronic pain. Public Health Relevance Paragraph: A compelling argument for the proposed study is to address the lack of clinical trials aimed at treating chronic pain in persons with disabilities; despite its high prevalence, the chronic pain problems experienced by persons with disabilities are not being adequately addressed. Given pain itself can be quite disabling, chronic pain as a secondary condition has the potential to contribute to disability and poor quality of life over and above the effects of the primary disability itself (Dworkin, 1997; Fordyce, 1976). The proposed study recognizes the importance of including persons with pain secondary to a disability in the study and treatment of chronic pain and acknowledges the need for developing effective treatments that are accessible yet low cost.

描述（由申请人提供）： 该研究的总体目的是提高我们对认知疗法干预是否以及如何减少继发于残疾的慢性疼痛患者的疼痛和与疼痛相关的功能障碍的理解。具体而言，该项目将：（1）通过一项随机临床试验，评估电话传递的认知疗法干预措施对慢性疼痛和获得截肢，多发性硬化症或脊髓损伤的成年人样本的疼痛疗效； （2）通过确定与治疗相关的认知变化（特别是灾难性的认知和控制信念）是否介导干预对疼痛的影响，研究认知疗法影响的潜在机制。这些目标将通过将残疾人和慢性疼痛（n = 160）随机分配给两个条件之一来实现。在第一种情况下，通过电话传递的认知疗法条件，参与者将获得认知疗法，专门指导他们采用认知策略（例如，识别适应不良的思维，认知重组，停止思维）瞄准疼痛灾难性，控制灾难，控制信念和其他负面思想。将通过电话提供干预措施，以减轻许多疼痛和残疾人面临的治疗障碍。第二个条件将是电话传递的疼痛教育条件，参与者将接受有关慢性疼痛的教育，但没有认知或行为疼痛管理策略的指导；因此，第二条件将作为注意力控制条件。如果支持研究假设，并且相对于教育条件而言，通过电话传递的认知疗法状况可有效减轻疼痛和改善功能，则该提案中使用的干预措施将是可以单独使用电话的基础，可以单独使用，或者可以将其置于跨学科的生物心理社会社会培训中，这些疗法与不利于疼痛的人互为疼痛。这些发现还将通过进一步发展我们对假设但很少检验的理论理解来推动疼痛治疗领域，而这些机制被认为是认知疗法对慢性疼痛的疗效的基础。 公共卫生相关性段落：拟议研究的一个令人信服的论点是解决旨在治疗残疾人慢性疼痛的临床试验的缺乏；尽管患病率很高，但残疾人遇到的慢性疼痛问题尚未得到充分解决。鉴于疼痛本身可能是残疾人，因此慢性疼痛作为次要疾病有可能导致残疾和差的生活质量，而不是主要残疾本身的影响（Dworkin，1997; Fordyce，1976）。拟议的研究认识到，在研究和治疗慢性疼痛的研究和治疗中，包括疼痛的人的重要性，并认识到需要开发有效治疗的有效治疗方法，这些治疗方法可访问但低成本。