■慢性疼痛在创伤性脑损伤(TBI)后很常见,经常限制日常活动,并与负面结果相关,例如社区参与减少。尽管慢性疼痛的负面影响,很少有TBI患者接受有效治疗。本文介绍了一种协作护理(CC)干预措施,TBI护理,专门用于治疗TBI患者的慢性疼痛,强调专家临床医生的投入,认知行为疗法(CBT)技术,和其他减少疼痛干扰的非药物方法。
■79名参与者来自两个学术医疗康复诊所,每周评估疼痛强度,干扰,和药物使用。参与者对干预的反馈通过在最后一个治疗阶段和/或加强阶段采访护理管理者(CM)来收集。提供者反馈是通过干预后的机密调查收集的。
■90%的参与者接受了至少11次与护理经理(CM)的目标12次会议,大多数是通过电话发生的。参与者平均认可7个疼痛部位。所有参与者都接受了疼痛教育,自我监控技能,目标设定/行为激活和放松训练。疼痛干扰评分(对活动和享受的影响),CM每周追踪一次,各届会议大幅下降。89%的参与者收到了关于CBT技能的建议,65%的人接受了针对疼痛干扰的额外治疗转诊,43%接受护理协调。75%的参与者在第一次和最后一次会议报告了6种或更多的药物/补充剂,建议的变化主要用于头痛治疗。参与者和提供者的反馈是积极的。
■TBI护理,一种新颖的以患者为中心的CC方法,灵活交付,适合患有TBI和慢性疼痛的人的需求,高水平的参与者参与,以及参与者和提供者之间的满意度。这种方法,优先考虑疼痛自我管理策略和其他非药物方法,随着优化药物治疗,导致干预期间自我报告的疼痛干扰和强度显著降低。在TBI中使用CC模型是可行的,并成功地改善了对慢性疼痛的循证治疗以及疼痛干扰和强度的结果。
■ClinicalTrials.gov,标识符NCT03523923。
UNASSIGNED: Chronic pain is common after traumatic brain injury (TBI), frequently limits daily activities, and is associated with negative outcomes such as decreased community participation. Despite the negative impact of chronic pain, few people with TBI receive effective treatment. This paper describes a collaborative care (CC) intervention, TBI Care, adapted specifically to treat chronic pain in people living with TBI, emphasizing expert clinician input, cognitive behavioral therapy (CBT) techniques, and other non-pharmacological approaches for decreasing pain interference.
UNASSIGNED: 79 participants engaged in the CC intervention from two academic medical rehabilitation clinics with weekly assessments of pain intensity, interference, and medication use. Participant feedback on the intervention was gathered by interview with the care manager (CM) at the last treatment session and/or booster session. Provider feedback was gathered by a confidential survey post intervention.
UNASSIGNED: Ninety percent of participants received at least 11 of the target 12 sessions with a care manager (CM), the majority occurring over the phone. Participants endorsed an average of 7 pain locations. All participants received pain education, skills in self-monitoring, goal setting/behavioral activation and relaxation training. Pain interference scores (impact on activity and enjoyment), tracked weekly by the CM, significantly decreased across sessions. 89% of participants received recommendations for CBT skills, 65% received referrals for additional treatments targeting pain interference, and 43% received care coordination. 75% of participants reported 6 or more medications/supplements at both the first and last session, with changes recommended primarily for headache treatment. Feedback from participants and providers was positive.
UNASSIGNED: TBI Care, a novel patient-centered CC approach, was flexibly delivered, tailored to the needs of those living with TBI and chronic pain, with a high level of participant engagement, and satisfaction among participants and providers. This approach, prioritizing pain self-management strategies and other non-pharmacological approaches, along with optimizing pharmacological treatment, led to significant reductions in self-reported pain interference and intensity during the intervention. Using a CC model in TBI is feasible and successfully improved access to evidence-based treatments for chronic pain as well as outcomes for pain interference and intensity.
UNASSIGNED: ClinicalTrials.gov, identifier NCT03523923.