Resilience Skills Self-Management for Chronic Pain

慢性疼痛的自我管理弹性技能

• 批准号: 10116990
• 负责人: Afton L Hassett
• 金额: $ 52.88万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-09 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10116990
• 关键词: Activities of Daily Living; Address; Adult; Affect; Age; American; Anxiety; Back; Behavior; Behavior Therapy; Behavioral; Cardiovascular Diseases; Caring; Cell Aging; Chronic; Clinical; Cognitive; Cognitive Therapy; Coronary heart disease; Data; Development; Diabetes Mellitus; Disease; Effectiveness; Emotions; Fatigue; Fibromyalgia; General Practices; Genomics; HIV; Health; Health Professional; Healthcare Systems; Individual; Institute of Medicine (U.S.); Intervention; Lead; Length; Malignant Neoplasms; Mediating; Medical; Mental Depression; Moods; Neck; Online Systems; Outcome Study; Pain; Pain interference; Pain management; Patients; Persistent pain; Personal Satisfaction; Pharmaceutical Preparations; Physical Function; Play; Population; Positioning Attribute; Public Health; Quality of life; Randomized Controlled Trials; Recommendation; Reporting; Resources; Role; Self Management; Severities; Sleep; Specialist; Spine pain; Standardization; Surveys; Symptoms; Telephone; Telomerase; Telomere Shortening; Therapeutic Intervention; Training; age related; arm; base; chronic pain; chronic pain management; chronic pain patient; clinical practice; cognitive enhancement; comorbidity; cost; cost estimate; disability; evidence base; functional status; improved; indexing; innovation; loss of function; mortality; online resource; pain outcome; pain patient; pain self-management; pain symptom; painful neuropathy; positive emotional state; post intervention; practice setting; premature; primary outcome; profession allied to medicine; programs; psychological stressor; public health relevance; reduce symptoms; resilience; response; secondary outcome; self-management program; skills; symptomatic improvement; targeted treatment; telomere; treatment as usual; treatment group

PROJECT SUMMARY / ABSTRACT Chronic spinal pain is associated with loss of function and significant disability. When spine pain is comorbid with fibromyalgia, symptom severity and disability are amplified. Interventions capable of improving functional status, reducing symptoms, and enhancing well-being are critically needed. Both medications and cognitive- behavioral therapy (CBT) have demonstrated similar, modest effects for reducing symptoms in chronic pain. Behavioral treatments for chronic pain like CBT act predominantly by decreasing negative states rather than by Resilience-based interventions target the enhancement of positive emotions and well-being rather than focusing solely on negative emotions and behaviors. Although relatively under-used in chronic pain populations, resilience-based interventions have been used successfully in other clinical settings including depression, cardiovascular disease, diabetes, and HIV. promoting positive states associated with resilience. Thus, adding resilience-enhancing strategies to CBT for pain holds promise for further enhancing the effectiveness of CBT. In addition, most current behavioral interventions require specialized training and as such are not widely available. Medical assistants (MAs) are well-positioned in the healthcare system to play a pivotal role in helping individuals with chronic pain improve their functional abilities through innovative self-management strategies. The MA-led self-management programs proposed herein leverage the unique training and capabilities of MAs, while considering minimizing costs and maintaining the flow of clinical practice. The benefits of resilience- enhanced CBT that targets increasing patient well-being are also expected to extend beyond pain to potentially include genomic effects. Telomere shortening is predictive of disease and mortality and is considered an index for premature cellular aging. Our pilot data suggest that in addition to age and other physical and psychological stressors, inadequately managed pain can also affect telomere attrition. Thus, in addition to demonstrating the efficacy of online CBT self-management with resilience-enhancing activities (CBTRE), this application seeks to evaluate the impact of CBTRE on telomere health. Our central hypothesis is that our MA-supported CBTRE program will demonstrate superior efficacy to standard MA-supported online CBT self-management (eCBT) alone (Aim 1) through the enhancement of well-being (Aim 2). Both the CBTRE and eCBT interventions will improve telomere health with greater benefits being attributable to the CBTRE condition due to the mediating benefits of well-being (Aim 3). Therefore, we will conduct a randomized controlled trial of 300 individuals with spinal pain who also meet fibromyalgia criteria to investigate the effectiveness of the CBTRE program in promoting functional status, improved symptoms, and genomic health using resources already in most medical settings (i.e., MAs). By demonstrating the ability of this self-management intervention to improve physical function, pain and other symptoms, as well as telomere health, we hope to improve the options available for the care of millions of people who suffer with chronic spinal pain.

项目摘要 /摘要 慢性脊柱疼痛与功能丧失和严重的残疾有关。当脊柱疼痛合并时 随着纤维肌痛，症状严重程度和残疾被放大。能够改善功能的干预措施 迫切需要状态，减轻症状和增强幸福感。药物和认知 - 行为疗法（CBT）表现出相似的，适度的影响，可减少慢性疼痛的症状。 慢性疼痛（如CBT）的行为治疗主要通过降低负面状态而不是通过 基于弹性的干预措施针对增强 积极的情绪和福祉，而不是仅专注于负面情绪和行为。虽然 在慢性疼痛群体中相对不足，基于弹性的干预措施已成功使用 在其他临床环境中，包括抑郁症，心血管疾病，糖尿病和HIV。 促进与弹性相关的积极国家。 因此，添加 CBT的弹性增强策略有望进一步提高CBT的有效性。 此外，大多数当前的行为干预措施需要专门的培训，因此并非广泛 可用的。医疗助理（MAS）在医疗保健系统中有良好的位置，可以在帮助方面发挥关键作用 患有慢性疼痛的人通过创新的自我管理策略来提高其功能能力。 在此提出的MA领导的自我管理计划利用了MAS的独特培训和能力， 同时考虑最小化成本并保持临床实践的流动。弹性的好处 - 预计靶向增加患者福祉的CBT也将超出疼痛的范围 包括基因组效应。端粒缩短是疾病和死亡率的预测，被认为是指数 用于过早的细胞衰老。我们的飞行员数据表明​​，除了年龄以及其他身体和心理 压力源，不充分管理的疼痛也会影响端粒损耗。因此，除了展示 在线CBT自我管理与弹性增强活动的功效（CBTRE），该应用程序试图 评估CBTRE对端粒健康的影响。我们的中心假设是我们的MA支持的CBTRE 计划将证明比标准MA支持的在线CBT自我管理（ECBT）的效率卓越 单独（目标1）通过增强幸福感（目标2）。 CBTRE和ECBT干预措施都将 改善端粒健康，由于介导而归因于CBTRE的更大好处 幸福的好处（AIM 3）。因此，我们将对300名患者进行随机对照试验 还符合纤维肌痛标准以研究CBTRE计划的有效性的脊柱疼痛 在大多数医学中使用资源促进功能状况，改善症状和基因组健康 设置（即MAS）。通过证明这种自我管理干预措施改善身体的能力 功能，疼痛和其他症状以及端粒健康，我们希望改善可用的选择 照顾数百万患有慢性脊柱疼痛的人。

项目成果

Multicenter Perioperative Outcomes Group Enhanced Observation Study Postoperative Pain Profiles, Analgesic Use, and Transition to Chronic Pain and Excessive and Prolonged Opioid Use Patterns Methodology.

多中心围手术期结果组增强观察研究术后疼痛概况、镇痛药使用、向慢性疼痛的过渡以及过度和长期阿片类药物使用模式方法。

• DOI: 10.1213/ane.0000000000004568
• 发表时间: 2020
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Stuart,AmiR;Kuck,Kai;Naik,BhikenI;Saager,Leif;Pace,NathanL;Domino,KarenB;Posner,KarenL;Alpert,SalomeB;Kheterpal,Sachin;Sinha,AnikK;Brummett,ChadM;Durieux,MarcelE;theMPOGEOSInvestigatorGroup
• 通讯作者: theMPOGEOSInvestigatorGroup

Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis.

• DOI: 10.1097/ajp.0000000000000619
• 发表时间: 2018-10
• 期刊: The Clinical journal of pain
• 作者: Neville SJ;Clauw AD;Moser SE;Urquhart AG;Clauw DJ;Brummett CM;Harte SE
• 通讯作者: Harte SE