Evidence-based Approaches to Chronic Pain Management in Youth with Sickle Cell Disease

镰状细胞病青少年慢性疼痛管理的循证方法

基本信息

批准号：
9384918
负责人：
Soumitri Sil
金额：
$ 15.16万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9384918
关键词：
Address Adolescent Adoption Affect African American Aftercare Age Automobile Driving Behavior Therapy Behavioral Caregiver Burden Caregivers Caring Caucasians Child Childhood Chronic Clinical Clinical Investigator Clinical Research Clinical Trials Cognitive Cognitive Therapy Communities Comorbidity Complex Data Development Development Plans Effectiveness Emergency Care Emergency department visit Enrollment Ensure Evaluation Evidence based intervention Evidence based treatment Family Feedback Focus Groups Frequencies Future Goals Health Health Care Costs Health Personnel Healthcare Hospitalization Individual Inpatients Instruction International Intervention Interview Knowledge Maintenance Medical Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Mind-Body Intervention Modeling Outcome Pain Pain interference Pain management Parents Pattern Pharmacology Physiology Prevention Psychosocial Factor Qualitative Methods Quality of life Research Research Infrastructure Research Project Grants Research Training Risk Factors Risk stratification Sickle Cell Sickle Cell Anemia Stress Testing Time Training Treatment Efficacy Universities Youth aged anxiety symptoms base biobehavior biopsychosocial career career development chronic pain clinically significant cohort coping depressive symptoms disability effective therapy evidence base experience flexibility follow-up health disparity health related quality of life implementation science improved individualized medicine informant innovation intervention program iterative design novel opioid use patient oriented pediatric patients prevent programs psychologic psychosocial racial disparity racism satisfaction secondary outcome socioeconomic disparity success therapy development

项目摘要

PROJECT SUMMARY Chronic pain is a complex and challenging problem associated with significant disability and suffering among children and adolescents with sickle cell disease (SCD). There is a gap in scientific knowledge in understanding the progression of chronic SCD pain that hinders the development of effective therapeutic options. Psychological treatments are key components of comprehensive chronic pain management, but currently have limited efficacy for managing SCD pain in youth. Thus, the long-term career goal of this candidate is to become an independent clinical investigator with expertise in SCD pain to establish a novel stepped care model of delivering behavioral interventions for SCD pain management that are easily implemented in real-world clinical settings. She will begin to achieve these goals by obtaining clinical and research training in SCD pain physiology and pharmacology and training in implementation science, health disparities research, and advanced quantitative and qualitative methods to support a patient-centered approach to pain intervention development, optimization, and evaluation. Her career development plan is uniquely tailored to fulfill gaps in her training in pediatric pain under the mentorship of national and international leaders at Emory University and Children’s Healthcare of Atlanta. The training plan leverages the well- supported infrastructure of the largest pediatric sickle cell program in the US as well as national and institutional opportunities to ensure didactic, experiential, and specialized individual instruction. The research objectives of this application are to first rigorously characterize trajectories of chronic pain over a 24-month period in a cohort of youth with SCD (ages 10-18 years). Data will help identify modifiable psychosocial and family risk factors (e.g., elevated anxiety or depressive symptoms, caregiver stress) that predict different chronic pain trajectories to inform relevant behavioral treatment targets in a family-focused cognitive-behavioral intervention. Standard qualitative and mixed-method approaches and iterative design using focus groups, key informant interviews, and community stakeholders will be used to develop and refine intervention content and format and solicit feedback to enhance the success of future implementation in clinical settings. The result will be a family-focused, culturally informed, evidence-based intervention termed Back2Living (“Building Adaptive Coping and Knowledge To improve daily Living”) that is amenable for implementation in real-world clinical settings. A pilot proof-of-concept trial will evaluate the feasibility, acceptability, and preliminary efficacy of Back2Living with youth with chronic SCD pain and their parents. An adaptive treatment approach with 4-8 treatment sessions selected on the basis of baseline assessment will target comorbid psychosocial risk factors and allow flexibility in tailoring treatment components to meet individual family needs to reduce pain interference, pain, and healthcare use. Results of this proposal may ultimately contribute to novel comprehensive treatment approaches to treat chronic pain in pediatric SCD and improve quality of life.

项目概要慢性疼痛是一个复杂且具有挑战性的问题，与严重的残疾和痛苦相关患有镰状细胞病（SCD）的儿童和青少年的科学知识存在差距。了解阻碍有效治疗方法开发的慢性 SCD 疼痛的进展心理治疗是综合慢性疼痛管理的关键组成部分，但是。目前治疗青少年 SCD 疼痛的效果有限，因此，这是其长期职业目标。候选人将成为一名独立的临床研究者，具有 SCD 疼痛方面的专业知识，以建立一种新颖的方法为 SCD 疼痛管理提供行为干预的阶梯式护理模式，易于操作她将通过获得临床和临床经验来开始实现这些目标。 SCD 疼痛生理学和药理学研究培训以及实施科学、健康方面的培训差异研究以及先进的定量和定性方法来支持以患者为中心的她的职业发展计划是疼痛干预开发、优化和评估的方法。在国家和国际专家的指导下，专门为填补她在儿科疼痛培训方面的空白而量身定制埃默里大学和亚特兰大儿童医疗中心的领导者的培训计划利用了良好的基础。支持美国以及国家和地区最大的儿科镰状细胞计划的基础设施确保教学式、体验式和专业化个人指导的机构机会。该应用程序的目标是首先严格描述 24 个月内慢性疼痛的轨迹患有 SCD 的青少年群体（10-18 岁）的一段时期数据将有助于确定可改变的心理社会和心理特征。家庭风险因素（例如，焦虑或抑郁症状加剧、照顾者压力）可预测不同的情况慢性疼痛轨迹可为以家庭为中心的认知行为中的相关行为治疗目标提供信息标准定性和混合方法以及使用焦点小组、关键的迭代设计。将利用知情者访谈和社区利益相关者来制定和完善干预内容和格式并征求反馈，以提高未来在临床环境中实施的成功率。成为一种以家庭为中心、了解文化、基于证据的干预措施，称为 Back2Living（“建立适应性应对和知识改善日常生活”）适合在现实世界的临床中实施试点概念验证试验将评估可行性、可接受性和初步功效。 Back2 与患有慢性 SCD 疼痛的青少年及其父母一起生活 4-8 的适应性治疗方法。根据基线评估选择的治疗疗程将针对共病心理社会风险因素并允许灵活地定制治疗组件，以满足各个家庭的需求，以减轻疼痛该提案的结果可能最终有助于创新。治疗小儿 SCD 慢性疼痛并提高生活质量的综合治疗方法。