SBIRT (Pain Management) for Veterans Filing Compensation Claims

描述（由申请人提供）：该拟议项目涉及修改和试点测试一个既定的SBIRT干预退伍军人正在评估疼痛性肌肉骨骼疾病（MSD）谁是物质使用障碍的风险。修改后的干预措施，SBIRT-PM（疼痛管理）是为退伍军人谁已提出索赔的（军事）服务相关的伤害，他们已要求经济赔偿。预测是，至少有一半的OEF/OIF/OND（持久自由行动，伊拉克自由，新黎明）退伍军人将有一些可补偿的服务连接条件与140,452已经补偿背部/颈部条件和其他关节条件的可比数字。对于很大一部分人来说，残疾评估是他们第一次接触V医疗保健。残疾评估是一个完美的时机，争取退伍军人在预防性干预，但这个机会通常是错过了。在我们小组完成的临床试验中， 试验，退伍军人申请赔偿创伤后应激障碍能够从事健康促进活动显着更频繁，如果他们接受积极的咨询时间左右， 他们的赔偿要求比对照组，但赔偿考试后的咨询还没有试点退伍军人申请默沙东。SBIRT-PM将由顾问在薪酬考试期间提供，并保证保密。顾问将解释，治疗疼痛的身体和心理方面导致最好的结果，并将概述退伍军人事务部提供的服务。在讨论了疼痛的管理和可能影响疼痛的事情后，顾问将解释说，虽然物质有时用于缓解疼痛，但它们会对疼痛控制产生负面影响。然后，顾问将转入SBIRT。该项目将包括两个阶段：（1）咨询优化阶段，在此期间，SBIRT-PM将在20名退伍军人中进行预试点，咨询会议结束后立即收集定性数据，并优化干预对退伍军人的吸引力;以及（2）一项随机临床试验，其中100名患有MSD和最近使用危险物质的退伍军人将被分配到无额外转诊条件，仅疼痛模块条件，或SBIRT-PM，比例为1：1：2，随访12周。估计的主要结果是危险物质使用周数的斜率。次要分析将估计疼痛强度的斜率以及物质使用和疼痛斜率的关系，控制变化阶段。在赔偿检查中进行筛查和转诊治疗可以将广泛使用的VA入口点转变为促进健康的接触。

DESCRIPTION (provided by applicant): This proposed project involves modifying and pilot-testing an established SBIRT intervention for Veterans being evaluated for painful musculoskeletal disorders (MSD) who are at risk for substance use disorders. The modified intervention, SBIRT-PM (Pain Management) is for Veterans who have filed a claim for a (military) service-connected injury for which they have requested financial compensation. Projections are that at least half of OEF/OIF/OND (Operations Enduring Freedom, Iraqi Freedom, New Dawn) Veterans will have some compensable service-connected condition with 140,452 already compensated for back/neck conditions and comparable numbers for other joint conditions. For a significant proportion, the disability evaluation is their first encounter with V healthcare. The disability evaluation is a perfectly-timed opportunity to enlist Veterans in a preventive intervention but this opportunity is typically missed. In our group's completed clinical trial, Veterans applying for Compensation for PTSD were able to be engaged in health-promoting activities significantly more often if they received active counseling around the time of their Compensation claim than controls, but counseling after Compensation exams has not been piloted in Veterans applying for MSD. SBIRT-PM will be delivered around the time of the Compensation examination by a counselor, with confidentiality assured. The counselor will explain that treating both physical and psychological aspects of pain leads to the best outcomes, and will outline what VA services are available to Veterans. After discussing management of pain and things that can impact pain, the counselor will then explain that while substances are sometimes used for pain relief, they can negatively impact pain control. The counselor will then segue into SBIRT. This project will involve two stages: (1) a Counseling Refinement phase during which SBIRT-PM will be pre-piloted in 20 Veterans, qualitative data will be collected immediately after counseling sessions, and the intervention's appeal to Veterans will be optimized; and (2) a randomized clinical trial in which 100 Veterans with MSD and recent risky substance use will be assigned to a No Additional Referral condition, a Pain Module Only condition, or SBIRT- PM in a 1:1:2 ratio and followed for 12 weeks. The primary outcome to be estimated is the slope of weeks with risky substance use. Secondary analyses will estimate the slope of pain intensity and the relationship of substance use and pain slopes, controlling for stage-of-change. Screening and referral to treatment at Compensation examinations can transform a widely-used point of entry to VA into a health-promoting encounter.