SBIRT (Pain Management) for Veterans Filing Compensation Claims

描述(由申请人提供)：这个拟议的项目涉及修改和试点测试为有物质使用障碍风险的痛性肌肉骨骼疾病(MSD)的退伍军人建立的SBIRT干预措施。修改后的干预措施，SBIRT-PM(疼痛管理)是为那些提出(军事)服务相关伤害索赔的退伍军人提供的，他们已经要求经济赔偿。据预测，至少有一半的OEF/OIF/OND(持久自由、伊拉克自由、新黎明行动)退伍军人将患有一些与服务相关的有偿疾病，其中140,452人已经因背部/颈部疾病得到补偿，其他关节疾病的补偿人数与之相当。对于很大一部分人来说，残疾评估是他们第一次遇到V级医疗保健。残疾评估是招募退伍军人进行预防性干预的一个非常及时的机会，但这个机会通常会被错过。在我们组完成的临床中 在试验中，申请创伤后应激障碍补偿的退伍军人如果在 他们的补偿要求高于对照组，但补偿考试后的咨询尚未在申请MSD的退伍军人中试点。SBIRT-PM将在确保保密的情况下，由一名顾问在薪酬审查的时间左右交付。辅导员将解释说，同时治疗身体和心理方面的疼痛会产生最好的结果，并将概述退伍军人可以获得哪些退伍军人服务。在讨论了疼痛的管理和可能影响疼痛的事情后，咨询师将解释说，虽然物质有时用于缓解疼痛，但它们可能会对疼痛控制产生负面影响。然后，辅导员将进入SBIRT。该项目将包括两个阶段：(1)咨询改进阶段，在此期间，将在20名退伍军人中预先试行SBIRT-PM，咨询会议结束后将立即收集定性数据，并优化干预措施对退伍军人的吸引力；(2)随机临床试验，100名患有MSD并最近使用危险物质的退伍军人将按1：1：2的比例被分配到无额外转诊条件、仅限疼痛模块条件或SBIRT-PM，并进行12周的跟踪。需要估计的主要结果是使用危险物质的几周的斜率。二次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，控制变化的阶段。在补偿检查中进行筛查和转诊治疗，可以将退伍军人管理局广泛使用的入口点转变为促进健康的相遇。

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.