The U.S. Department of Veterans Affairs (VA) has been training clinicians in its cognitive behavioral therapy for chronic pain (CBT-CP) structured protocol since 2012. The aim of this project was to review patient outcomes to determine the effectiveness of the VA's CBT-CP treatment. From 2012-2018, 1,331 Veterans initiated individual CBT-CP treatment as part of the training program. Patient outcomes were assessed with measures of patient-reported pain intensity, pain catastrophizing, depression, pain interference, and quality of life (physical, psychological, social, and environmental). Mixed models of the effects of time indicated significant changes across pretreatment, midtreatment, and treatment conclusion on all outcomes. There was a large effect size (Cohen's d = 0.78) for pain catastrophizing, and there were medium to large effect sizes (d > 0.60) for worst pain intensity, pain interference, depression, and physical quality of life. Systematic training of therapists and implementation of the VA's CBT-CP protocol yielded significant patient improvements across multiple domains. This offers strong support for the VA's CBT-CP as an effective, safe treatment for Veterans with chronic pain and highlights it as a model to increase the availability of training in standardized, pain-focused, evidence-based, behavioral interventions. The findings suggest that the broad dissemination of such training, including in routine, nonpain specialty settings, would improve patient access to effective, nonpharmacological treatment options in both the public and private sectors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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退伍军人慢性疼痛的认知行为疗法：模型程序中临床有效性的证据。

自 2012 年以来，美国退伍军人事务部 (VA) 一直在对临床医生进行慢性疼痛认知行为疗法 (CBT-CP) 结构化方案的培训。该项目的目的是审查患者的治疗效果，以确定 VA 的 CBT- CP治疗。从 2012 年到 2018 年，作为培训计划的一部分，1,331 名退伍军人开始了个人 CBT-CP 治疗。通过测量患者报告的疼痛强度、疼痛灾难化、抑郁、疼痛干扰和生活质量（身体、心理、社会和环境）来评估患者结果。时间影响的混合模型表明，在所有结果上，治疗前、治疗中期和治疗结论都发生了显着变化。疼痛灾难化的效应量很大 (Cohen's d = 0.78)，最严重的疼痛强度、疼痛干扰、抑郁和身体生活质量具有中到大的效应值 (d > 0.60)。治疗师的系统培训和 VA 的 CBT-CP 协议的实施在多个领域产生了显着的患者改善。这为 VA 的 CBT-CP 作为对患有慢性疼痛的退伍军人提供有效、安全的治疗方法提供了强有力的支持，并强调它是一个模型，可以增加标准化、以疼痛为中心、以证据为基础的行为干预培训的可用性。研究结果表明，广泛传播此类培训，包括在常规的非疼痛专科环境中，将改善患者在公共和私营部门获得有效的非药物治疗选择的机会。（PsycInfo 数据库记录 (c) 2020 APA，保留所有权利）。