Behavioral cancer pain intervention dosing: results of a Sequential Multiple Assignment Randomized Trial.

Autor:	Somers TJ; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Winger JG; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Fisher HM; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Hyland KA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Davidian M; Department of Statistics, North Carolina State University, Raleigh, NC, United States., Laber EB; Department of Statistical Sciences, Duke University, Durham, NC, United States., Miller SN; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Kelleher SA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Plumb Vilardaga JC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Majestic C; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Shelby RA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States., Reed SD; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States., Kimmick GG; Duke University School of Medicine/Duke Cancer Institute, Durham, NC, United States., Keefe FJ; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.
Jazyk:	angličtina
Zdroj:	Pain [Pain] 2023 Sep 01; Vol. 164 (9), pp. 1935-1941. Date of Electronic Publication: 2023 Apr 20.
DOI:	10.1097/j.pain.0000000000002915
Abstrakt:	Abstract: Behavioral pain management interventions are efficacious for reducing pain in patients with cancer. However, optimal dosing of behavioral pain interventions for pain reduction is unknown, and this hinders routine clinical use. A Sequential Multiple Assignment Randomized Trial (SMART) was used to evaluate whether varying doses of Pain Coping Skills Training (PCST) and response-based dose adaptation can improve pain management in women with breast cancer. Participants (N = 327) had stage I-IIIC breast cancer and a worst pain score of > 5/10. Pain severity (a priori primary outcome) was assessed before initial randomization (1:1 allocation) to PCST-Full (5 sessions) or PCST-Brief (1 session) and 5 to 8 weeks later. Responders ( > 30% pain reduction) were rerandomized to a maintenance dose or no dose and nonresponders (<30% pain reduction) to an increased or maintenance dose. Pain severity was assessed again 5 to 8 weeks later (assessment 3) and 6 months later (assessment 4). As hypothesized, PCST-Full resulted in greater mean percent pain reduction than PCST-Brief (M [SD] = -28.5% [39.6%] vs M [SD]= -14.8% [71.8%]; P = 0.041). At assessment 3 after second dosing, all intervention sequences evidenced pain reduction from assessment 1 with no differences between sequences. At assessment 4, all sequences evidenced pain reduction from assessment 1 with differences between sequences ( P = 0.027). Participants initially receiving PCST-Full had greater pain reduction at assessment 4 ( P = 0.056). Varying PCST doses led to pain reduction over time. Intervention sequences demonstrating the most durable decreases in pain reduction included PCST-Full. Pain Coping Skills Training with intervention adjustment based on response can produce sustainable pain reduction. (Copyright © 2023 International Association for the Study of Pain.)
Databáze:	MEDLINE
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