Adaptation of Mindfulness Training to Treat Chronic Pain in the Military

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DESCRIPTION (provided by applicant): Chronic pain is a significant public health priority for society, including the military. This application will test the acceptability and feasibility of an interactive, web-based mindfulness training with active duty soldiers being treated for chronic pain. We will adapt the evidence-based Mindfulness-based Stress Reduction (MBSR) program for use with this population. The training will be enhanced by mobile applications (apps) for skill practice, using an existing apps platform. Study participants will be recruited from the Interdisciplinary Pain Management Center at Womack Army Medical Center (WAMC) in Fort Bragg, NC, one of eight IPMCs nationally whose work is setting the standard for the DoD through its interdisciplinary, holistic, and multimodal approach to pain management. Rates of chronic pain in the military are exceedingly high, ranging from 28% to 82%. Estimated disability and medical costs for Iraq and Afghanistan veterans range from $350 to $700 billion. Chronic pain in the military often co-occurs with depression, post-traumatic stress disorder, traumatic brain injury, and drug and alcohol misuse. MBSR has a well-established evidence base and is efficacious in reducing depression, anxiety, stress, insomnia, and substance abuse. MBSR is also effective in ameliorating pain symptoms. However, the military's unique context differs dramatically from the civilian setting. These variations impact the feasibility and acceptability o the standard MBSR training, underscoring need for a preliminary study that includes a skillful adaptation process, a pretest, and a pilot test, thus laying the groundwork for a larger efficacy trial. The specific aims of this study are as follows: Aim 1. Adapt the evidence-based MBSR program for the military and add apps to an existing platform to develop a preliminary protocol. Aim 2. Assess the usability of the web-based preliminary protocol and apps at an early, pretest stage (1 group; N=8) in order to manualize and create a test protocol; Aim 3. Test the feasibility and acceptability of the test protocol and apps (4-5 sequential groups; N=32-40). The mindfulness protocol will be delivered via an existing web-based platform that enhances program accessibility and reach. The apps will utilize an existing platform that was developed by a team member with DoD funding, thus saving costs; the DoD is highly supportive of its expanded use. The investigative team includes researchers with in-depth experience in mindfulness, adaptation of evidence-based programs, mobile health technology, and military health research. This acceptability and feasibility study has significant