Evidence-Based Pain Intervention for Veterans: Leveraging Mobile & Social Media

描述（由申请人提供）：慢性肌肉骨骼疼痛造成了重大的公共卫生负担。退伍军人不成比例地受到慢性肌肉骨骼疼痛的影响，特别是慢性腰痛（CLBP）。疼痛与创伤后应激障碍（PTSD）、疼痛与创伤性脑损伤（TBI）以及所有三种情况（部署后多症状障碍（PMD））共同发生的频率和程度可使疼痛治疗复杂化并降低疗效。2011年美国缓解疼痛医学研究所蓝图呼吁促进自我管理；减少弱势亚群体（包括退伍军人）之间的差距；以及为每位患者量身定制的疼痛护理。支持综合治疗PMD或同时伴有创伤性脑损伤或创伤后精神紧张性精神障碍的人，提倡提供针对多种情况的干预措施。拟议的研究代表了对这些建议的创新回应，因为它将开发和检查Sx3的可行性，可接受性和初步效果：疼痛，睡眠和压力管理的自我管理，这是一个基于理论的，移动优化的，基于互联网的，交互式的慢性肌肉骨骼疼痛自我管理程序。与任何现有的疼痛干预不同，Sx3: 1)是专门为退伍军人准备采取自我管理和偏好疼痛管理策略而量身定制的；2)结合了有前景的综合治疗PMD的两个核心组成部分，适用于有合并症的退伍军人：睡眠卫生和压力管理（放松训练）；3)利用社交网络、游戏原则和短信来提高用户粘性和留存率。与国家疼痛自我管理专家Robert Kerns博士合作开发的计算机定制干预（CTI）将包括一个动态的个人活动中心，健康游戏原则，社交网络功能和可选的文本信息。广泛的最终用户和利益相关者的投入将确保Sx3的设计能够迅速传播。形成性焦点小组参与者（n=60）；可用性测试（n=20）；试点测试（n=50）将从VA康涅狄格医疗保健系统招募。形成性焦点小组的反馈将与专家的意见相结合，以开发一个引人入胜的自我管理项目的原型，该项目是为准备采用和偏好包含睡眠卫生和压力管理的疼痛应对技能而量身定制的。可用性测试将使原型在30天的试运行前得到完善。试点参与者将提供定量和定性的可接受性数据，并对利用数据进行审查。疼痛强度前后比较；身体和情感功能；患者对变化的整体印象；准备好接受痛苦应对技巧将为该项目的效果提供初步数据。这些数据将为进行II期有效性试验所需的程序修改提供信息。第二阶段将为具有成本效益的、基于证据的、以人群为基础的项目的商业化提供动力，该项目有可能改善疼痛自我管理、功能和福祉。

DESCRIPTION (provided by applicant): Chronic musculoskeletal pain creates a significant public health burden. Veterans are disproportionately affected by chronic musculoskeletal pain, and in particular, chronic low back pain (CLBP). The frequency and extent of co-occurrence of pain and PTSD, pain and Traumatic Brain Injury (TBI), and all three conditions (Post-deployment Multi-symptom Disorder (PMD)) can complicate and reduce the effectiveness of treatment for pain. The 2011 Institute of Medicine Blueprint for Relieving Pain in America calls for the promotion of self- management; reducing disparities among vulnerable subgroups (including Veterans); and the tailoring of pain care to each patient. Proponents of integrated treatment for PMD or the co-occurrence of pain with either TBI or PTSD are advocating for delivery of interventions that address multiple conditions. The proposed research represents an innovative response to those recommendations in that it will develop and examine the feasibility, acceptability, and preliminary effects of Sx3: Self Management of Pain, Sleep, & Stress Management a theoretically-grounded, mobile-optimized, Internet-based, interactive pain self-management program for chronic musculoskeletal pain. Unlike any existing pain intervention, Sx3: 1) is tailored specifically for Veterans' readiness to adopt self-management and preference for pain management strategies; 2) incorporates two of the core components of promising integrated treatments for PMD that are appropriate for Veterans with co-morbidities: sleep hygiene and stress management (relaxation training); and 3) leverages social networking, gaming principles, and SMS messaging to increase engagement and retention. Developed in collaboration with national pain self-management expert Dr. Robert Kerns, the computer- tailored intervention (CTI) will include a dynamic personal activity center, principles of gaming for health, social networking features, and optional text messages. Extensive end user and stakeholder input will ensure Sx3 is designed for rapid dissemination. Participants for formative focus groups (n=60); usability testing (n=20); and a pilot test (n=50) will be recruited from VA Connecticut Healthcare System. Formative focus group feedback will be combined with expert input to develop a prototype of an engaging self-management program tailored to readiness to adopt and preference for pain coping skills that incorporates sleep hygiene and stress management. Usability testing will allow the prototype to be refined before a 30-day pilot. Pilot participants will provide quantitative and qualitative acceptability data, and utilization data wil be examined. Pre-post comparisons of pain intensity; physical and emotional functioning; Patient Global Impression of Change; and readiness to adopt pain coping skills will provide preliminary data on the effects of the program. These data will inform program modifications needed to proceed with the Phase II effectiveness trial. Phase II will provide the impetus for commercialization of a cost-effective, evidence-based, population-based program that has the potential to improve pain self-management, functioning, and well-being.