Mindful Action for Pain: An Integrated Approach to Improve Chronic Pain Function

正念疼痛行动：改善慢性疼痛功能的综合方法

• 批准号: 10396993
• 负责人: Matthew Herbert
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10396993
• 关键词: Address; Adherence; Affect; Attention; Awareness; Client satisfaction; Clinical; Clinical Research; Clinical Trials; Cognitive Therapy; Dose; Economic Burden; Emotions; Evidence based treatment; Expectancy; Feeling; Future; Goals; Gold; Health Care Costs; Individual; Intervention; Intervention Trial; Investigation; Lead; Life; Light; Measures; Mediating; Meditation; Mentors; Methods; Modeling; Outcome; Outcome Measure; Pain; Pain interference; Pain management; Participant; Patient Outcomes Assessments; Phase; Physical Function; Physical activity; Principal Investigator; Process; Proxy; Psychological Impact; Psychophysics; Psychosocial Factor; Quality of life; Randomized; Research Personnel; Research Support; Scientist; Testing; Thinking; Training; Treatment outcome; Veterans; Veterans Health Administration; actigraphy; base; bodily sensation; chronic pain; chronic pain management; cost; design; diaries; disability; efficacy trial; evidence base; experience; falls; flexibility; functional improvement; functional outcomes; improved; indexing; innovation; meetings; military veteran; mindfulness; mindfulness intervention; mindfulness meditation; novel; pain catastrophizing; pain outcome; post intervention; psychologic; psychosocial; randomized trial; recruit; response; retention rate; social; therapy development; tool; trait

Chronic pain, defined as persistent or episodic pain that does not resolve with treatment, affects up to 50% of Veterans, costs the nation between $560 and $635 billion dollars annually, and is associated with high rates of disability and low quality of life. According to the 2009 Veterans Health Administration (VHA) Directive, the goal of pain treatment is to improve physical and psychosocial functioning, emphasizing non- pharmacological approaches, such as psychosocial interventions, to target psychosocial factors that maintain disability. Unfortunately, the gold standard psychosocial intervention for chronic pain, Cognitive Behavioral Therapy (CBT), does not reliably produce meaningful increases in function. Veterans would greatly benefit from innovative and theoretically-grounded alternative psychosocial interventions for chronic pain. An emerging scientific model that has been applied to chronic pain is the psychological flexibility (PF) model. PF refers to the ability to behave consistently with one's values even in the face of unwanted thoughts, feelings, and bodily sensations such as pain. Acceptance and Commitment Therapy (ACT) is the best known treatment derived from the PF model and is as effective as the gold standard CBT, but still falls short on achieving meaningful changes in functional improvement. Although ACT was designed to impact PF, methods from different treatment approaches are also consistent with the model. An experiential strategy that holds promise for enhancing PF is formal mindfulness meditation, a practice used to train non-judgmental awareness and attention to present-moment experiences, which has never been tested within the PF model. There is compelling theoretical and empirical rationale that the mechanisms underlying formal mindfulness meditation will bolster PF processes and thereby can be applied to facilitate functional improvement. To test this, Dr. Herbert, the principal investigator (PI), has developed a novel 8-week group-based intervention, Mindful Action for Pain (MAP), which integrates formal mindfulness meditation with experiential methods from different evidence-based treatment approaches in accordance with the PF model. MAP is designed such that daily mindfulness meditation practice is used to develop the capacity to more completely utilize strategies to address the key psychosocial barriers (e.g., pain catastrophizing) to optimal functioning. The proposed CDA-2 consists of two phases. Phase 1 (years 1 – 2) consists of using qualitative and quantitative methods to iteratively develop and refine MAP (n = 20). Phase 2 (years 3 – 5) consists of a pilot randomized trial (n = 86) of MAP vs. CBT for chronic pain (CBT-CP) in order to establish feasibility of a future large-scale trial and estimate the preliminary impact of MAP. Functional improvement will be measured by reductions in pain interference (primary clinical outcome). Further, meditation adherence will be assessed to explore dose-response relationships with functional improvement, and objective measures of physical activity (actigraphy) will be captured to explore the psychophysical impact of MAP. The PF model is a progressive scientific model that is consistent with VHA goals for chronic pain management, but so far interventions developed based on this model (i.e., ACT) are not accomplishing the goals set forth by the VHA. Therefore, we seek to fully develop and estimate the preliminary impact of a novel, integrated intervention that is consistent with the PF model. In MAP, formal mindfulness meditation and evidence-based experiential methods are taught as practical tools to help participants remain present moment focused while accepting and creating distance with ongoing unpleasant thoughts, emotions, and pain in order to actively pursue meaningful life directions. Findings from the proposed study have the potential of substantially increasing the physical and psychosocial functioning of Veterans with chronic pain, and also have the potential of reducing the social and economic burden of chronic pain.

慢性疼痛，定义为治疗无法缓解的持续性或阵发性疼痛，影响最多 50% 的退伍军人每年花费国家 560 至 6350 亿美元，并且与高 根据 2009 年退伍军人健康管理局 (VHA) 指令， 疼痛治疗的目标是改善身体和社会功能，强调非 药理学方法，例如心理社会干预，针对维持健康的心理社会因素 不幸的是，慢性疼痛的黄金标准心理社会干预是认知行为干预。 治疗（CBT）不能可靠地产生有意义的功能增强，退伍军人将受益匪浅。 来自针对慢性疼痛的创新且有理论依据的替代心理社会干预措施。 应用于慢性疼痛的新兴科学模型是心理灵活性（PF） PF模型是指即使面对不想要的想法也能按照自己的价值观行事的能力， 感受和身体感觉，例如疼痛，接受和承诺疗法（ACT）是最著名的。 源自 PF 模型的治疗方法与黄金标准 CBT 一样有效，但仍存在不足 尽管 ACT 旨在影响 PF，但方法却实现了有意义的改变。 不同治疗方法的结果也与该模型一致。 增强 PF 的承诺是正式的冥想正念，这是一种用于训练非评判意识的练习 以及对当下体验的关注，这在 PF 模型中从未得到过检验。 令人信服的理论和经验原理表明正式正念冥想的机制 将加强 PF 流程，从而可用于促进功能改进。 首席研究员 (PI) 赫伯特 (Herbert) 开发了一种新颖的为期 8 周的小组干预措施：正念行动 (Mindful Action) for Pain (MAP)，它将正式的正念冥想与来自不同领域的体验方法相结合 根据 MA​​P 模型设计循证治疗方法，以便每天进行。 正念冥想练习用于培养更全面地利用策略来解决问题的能力 影响最佳功能的关键社会心理障碍（例如，将疼痛灾难化）。 拟议的 CDA-2 由两个阶段组成，第 1 阶段（第 1-2 年）包括使用定性和评估。 迭代开发和完善 MAP 的方法 (n = 20) 第 2 阶段（第 3 – 5 年）包括试点。 MAP 与 CBT 治疗慢性疼痛 (CBT-CP) 的随机试验 (n = 86)，以确定未来的可行性 大规模试验并估计 MAP 的功能改善的初步影响将通过以下方式来衡量。 此外，将评估冥想的依从性，以减少疼痛干扰（主要临床结果）。 探索与功能改善的剂量反应关系以及体力活动的客观测量 （活动记录）将被捕获以探索 MAP 对心理物理的影响。 PF模型是一种进步的科学模型，与慢性疼痛的VHA目标一致 管理，但到目前为止，基于该模型（即 ACT）开发的干预措施尚未实现 因此，我们力求充分开发和评估一部小说的初步影响， 与 PF 模型一致的综合干预，即正式的正念冥想和 基于证据的体验方法作为实用工具进行教授，以帮助保持当下时刻 集中注意力，同时接受持续存在的不愉快的想法、情绪和痛苦并与之保持距离 积极追求有意义的生活方向 拟议研究的结果有潜力。 显着提高患有慢性疼痛的退伍军人的身体和心理社会功能，并且还具有 减少慢性疼痛的社会和经济负担的潜力。