基于网络的认知行为疗法治疗伴有异常药物相关行为的慢性疼痛患者：一项随机对照试验的结果。
Web-Based Cognitive Behavior Therapy for Chronic Pain Patients with Aberrant Drug-Related Behavior: Outcomes from a Randomized Controlled Trial.
机构信息
National Development and Research Institutes (NDRI), Inc., New York, New York.
Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire.
出版信息
Pain Med. 2018 Dec 1;19(12):2423-2437. doi: 10.1093/pm/pnx334.
OBJECTIVE
There is high unmet need for effective behavioral treatments for chronic pain patients at risk for or with demonstrated histories of opioid misuse. Despite growing evidence supporting technology-based delivery of self-management interventions for chronic pain, very few such programs target co-occurring chronic pain and aberrant drug-related behavior. This randomized controlled trial evaluated the effectiveness of a novel, web-based self-management intervention, grounded in cognitive behavior therapy, for chronic pain patients with aberrant drug-related behavior.
METHODS
Opioid-treated chronic pain patients at a specialty pain practice who screened positive for aberrant drug-related behavior (N = 110) were randomized to receive treatment as usual plus the web-based program or treatment as usual alone. The primary outcomes of pain severity, pain interference, and aberrant drug-related behavior, and the secondary outcomes of pain catastrophizing and pain-related emergency department visits, were assessed during the 12-week intervention and at one and three months postintervention.
RESULTS
Patients assigned to use the web-based program reported significantly greater reductions in aberrant drug-related behavior, pain catastrophizing, and pain-related emergency department visits-but not pain severity or pain interference-relative to those assigned to treatment as usual. The positive outcomes were observed during the 12-week intervention and for three months postintervention.
CONCLUSIONS
A web-based self-management program, when delivered in conjunction with standard specialty pain treatment, was effective in reducing chronic pain patients' aberrant drug-related behavior, pain catastrophizing, and emergency department visits for pain. Technology-based self-management tools may be a promising therapeutic approach for the vulnerable group of chronic pain patients who have problems managing their opioid medication.
目的
对于有或有过阿片类药物滥用风险或病史的慢性疼痛患者，有效行为治疗的需求未得到满足。尽管越来越多的证据支持基于技术的慢性疼痛自我管理干预措施，但很少有此类计划针对同时存在的慢性疼痛和异常药物相关行为。本随机对照试验评估了一种基于认知行为疗法的新型网络自我管理干预措施对有异常药物相关行为的慢性疼痛患者的有效性。
方法
在一家专门的疼痛诊所，接受阿片类药物治疗的慢性疼痛患者，如果对异常药物相关行为进行筛查呈阳性（N=110），则随机分配接受常规治疗加基于网络的方案或单独常规治疗。主要结局为疼痛严重程度、疼痛干扰和异常药物相关行为，次要结局为疼痛灾难化和与疼痛相关的急诊就诊，在 12 周干预期间和干预后 1 个月和 3 个月进行评估。
结果
与接受常规治疗的患者相比，使用基于网络的方案的患者报告异常药物相关行为、疼痛灾难化和与疼痛相关的急诊就诊显著减少，但疼痛严重程度或疼痛干扰没有减少。这些积极结果在 12 周干预期间和干预后 3 个月观察到。
结论
当与标准专业疼痛治疗一起提供时，基于网络的自我管理计划可有效减少慢性疼痛患者的异常药物相关行为、疼痛灾难化和因疼痛而就诊急诊。基于技术的自我管理工具可能是一种有前途的治疗方法，适用于管理阿片类药物有问题的慢性疼痛患者这一脆弱群体。
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