Intensive Treatment of Chronic Pain and PTSD for OEF/OIF Veterans

描述（由申请人提供）： OEF/OIF退伍军人慢性疼痛和创伤后应激障碍的强化治疗目的：本研究的主要目的是评估对患有慢性疼痛和创伤后应激障碍（PTSD）共病的持久自由行动和伊拉克自由行动（OEF/OIF）退伍军人进行强化综合治疗的疗效。第二个目标是检查可能导致疼痛或PTSD改善的潜在作用机制。第三，将进行探索性分析，以评估参与治疗与认知功能之间的关系。假设1）与随机分配到标准护理（SC）条件的参与者相比，接受强化治疗（PT）的参与者将报告从治疗前到治疗后疼痛和PTSD症状的显著更大减少，和2）接受PT治疗的受试者在治疗完成后3个月时，参与者被随机分配到SC条件。研究设计：拟定的研究是一项两种治疗条件（强化综合疼痛和PTSD治疗（PT）与标准治疗（SC）），三个评价期（治疗前、治疗后和3个月随访），重复测量设计，具有多个依赖性指标。方法学：参与者将是102名OEF/OIF退伍军人，他们在VA波士顿和VA康涅狄格州医疗保健系统接受护理，患有慢性疼痛和PTSD的共病诊断。如果患者因神经或肌肉骨骼病因持续疼痛至少3个月，则有资格参加研究。患者还必须符合DSM-IV的PTSD诊断标准。将排除患有危及生命或急性身体疾病、当前酒精或药物滥用、当前精神病或自杀意念的患者以及寻求疼痛治疗（如手术干预）的个体。访谈、自我报告方法和神经心理学测试将用于进行参与者评估。随机分配至PT条件的受试者将参加6次每两周一次的门诊治疗，每次治疗持续90分钟。随机分配至SC条件的受试者将通过VA继续接受标准医疗护理。分析将检查每个条件的影响以及组间影响。 公共卫生相关性： 持久行动和伊拉克自由项目（OEF/OIF）导致越来越多的受伤士兵被疏散到美国，接受与身心创伤有关的综合护理，最常见的是疼痛和创伤后应激障碍（PTSD）。这些疾病往往共同发生，并导致高水平的痛苦症状。因此，必须在这些疾病变成慢性病和难以改变之前，为它们开发有效、省时的治疗方法。本研究通过简短、综合的治疗形式调查了OEF/OIF退伍军人慢性疼痛和创伤后应激障碍的治疗。研究目标与VHA国家疼痛管理策略一致，该策略确保VA医疗保健系统中的所有患者都可以可靠地获得及时和适当的疼痛治疗。这项研究的最终目的是帮助OEF/OIF退伍军人谁是痛苦的社会，职业和个人由于他们的痛苦和创伤后应激障碍，旨在帮助退伍军人迅速恢复到一个更适应，健康的日常生活。

DESCRIPTION (provided by applicant): ABSTRACT Intensive Treatment of Chronic Pain and PTSD for OEF/OIF Veterans Objectives: The primary objective of this study is to evaluate the efficacy of an intensive integrated treatment for Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans with comorbid chronic pain and posttraumatic stress disorder (PTSD). A secondary objective is to examine potential mechanisms of action that might account for improvements in pain or PTSD. Third, exploratory analyses will be conducted to assess the relationship between participation in treatment and cognitive functioning. It is hypothesized that 1) participants receiving the intensive treatment (PT) will report significantly greater decreases in symptoms of pain and PTSD from pre-treatment to post-treatment when compared to participants randomized to a standard care (SC) condition, and 2) participants receiving PT will show greater maintenance of change on measures of pain and PTSD at 3 months following the completion of treatment when compared to participants randomized to the SC condition. Research Design: The proposed study is a two treatment condition (Intensive Integrated Pain and PTSD Treatment (PT) vs. Standard Care (SC)) by three evaluation period (pre-treatment, post-treatment, and 3-month follow-up) repeated measures design with multiple dependent measures. Methodology: Participants will be 102 OEF/OIF veterans receiving care in the VA Boston and VA Connecticut Healthcare Systems with a co-morbid diagnosis of chronic pain and PTSD. Patients will be eligible to participate if they have constant pain of at least three months duration with a neurologic or musculoskeletal etiology. Patients must also meet DSM-IV diagnostic criteria for PTSD. Patients with life threatening or acute physical illness, current alcohol or substance abuse, current psychosis or suicidal ideation, and individuals seeking pain treatment such as surgical interventions will be excluded. Interview, self-report methodology, and neuropsychological testing will be utilized to conduct participant assessments. Participants randomized to the PT condition will attend 6 bi-weekly outpatient therapy sessions conducted in an individual format of 90 minutes in duration. Participants randomized to the SC condition will continue to receive standard medical care through the VA. Analyses will examine the effects of each condition as well as between group effects. PUBLIC HEALTH RELEVANCE: Project Narrative Operations Enduring and Iraqi Freedom (OEF/OIF) have resulted in a growing number of injured soldiers who have been evacuated to the United States for comprehensive care related to both physical and psychological trauma, most commonly pain and Post-Traumatic Stress Disorder (PTSD). These disorders tend to co-occur and result in high levels of distressing symptoms. Thus, it is imperative to develop effective, time-efficient treatments for these disorders before they become chronic and resistant to change. This study investigates the treatment of chronic pain and PTSD in OEF/OIF veterans through a brief, integrated treatment format. The study goals are consistent with the VHA National Pain Management Strategy, which assures that all persons cared for in the VA healthcare system can reliably count on prompt and appropriate treatment of pain. This study ultimately aims to help OEF/OIF veterans who are suffering socially, vocationally, and personally due to their pain and PTSD and aims to help veterans return quickly to a more adaptive, healthy daily life.