Pain Management using Mobile Technology in Veterans with PTSD and TBI

使用移动技术对患有 PTSD 和 TBI 的退伍军人进行疼痛管理

• 批准号: 9096037
• 负责人: ERIC B. ELBOGEN
• 金额: $ 15.2万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9096037
• 关键词: Adherence; Afghanistan; Ambulatory Care Facilities; Analgesics; Behavioral; Benchmarking; Biofeedback; Brain; Calendar; Caring; Clinic; Clinical; Data; Development; Devices; Distress; Drug abuse; Drug usage; Economics; Educational process of instructing; Effectiveness; Electroencephalography; Emotional; Enrollment; Ensure; Freedom; Funding; Future; Goals; Grant; Health; Home environment; Home visitation; House Call; Individual; Institution; Intervention; Iraq; Link; Measures; Mental Health; Military Personnel; National Institute of Mental Health; North Carolina; Operations Research; Outcome; Pain; Pain management; Participant; Personal Satisfaction; Pharmacological Treatment; Physiological; Post-Traumatic Stress Disorders; Publishing; Randomized Clinical Trials; Reading; Registries; Relaxation; Reporting; Research; Research Personnel; Risk; Schedule; Suicide; Technology; Telephone; Testing; Time; Touch sensation; Translating; Traumatic Brain Injury; Travel; Triad Acrylic Resin; Universities; Use Effectiveness; Veterans; Violence; Work; alternative treatment; base; chronic pain; clinical practice; cognitive function; cost; dual diagnosis; effective intervention; high risk; improved; improved outcome; innovation; meetings; mobile computing; neurofeedback; neuroimaging; new technology; operation; opioid abuse; pain symptom; post intervention; programs; social; social stigma; success; symptom treatment; therapy design; tool; traditional care; usability

DESCRIPTION (provided by applicant): Up to half of military veterans with traumatic brain injury (TBI) also suffer from co-occurring posttraumatic stress disorder (PTSD). Both are linked to higher risk of chronic pain, one of the most common health complaints among U.S. veterans who served in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and Operation New Dawn (OEF/OIF/OND). However, pain medications elevate risk of opioid abuse, and studies indicate that veterans perceive barriers to traditional mental health treatments. Littl research exists regarding non-pharmacological, technology-based interventions designed to reduce pain in veterans with PTSD and TBI. Mobile technology used to implement neurofeedback (EEG biofeedback) shows promise in providing a portable, low-cost intervention for reducing pain in veterans with co-occurring disorders. In the current R34, we aim to test the feasibility and effectiveness of using mobile neurofeedback devices for reducing pain symptoms in veterans with PTSD and TBI. N=100 OED/OIF/OND veterans with PTSD, TBI, and chronic pain will receive a NeuroSky headset (which reads EEG brain waves) and an iPod Touch with an app called "Cortex EEG" (which provides neurofeedback to induce physiological relaxation). NeuroSky and Cortex EEG are linked via Bluetooth, and veterans are taught how to use these together to do neurofeedback. With staff assistance, veterans will also enter a schedule and reminders into the iPod calendar to practice neurofeedback by themselves at home or other preferred setting 20 minutes a day, 4 times a week, for 12 weeks. Comprehensive data will be collected before and after the intervention. In the intervening period, we will collect data on app utilization twice by phone and conduct a home visit to practice neurofeedback, troubleshoot technical problems, and collect data on utilization. Guided by existing research and preliminary data, we hypothesize that 80% of participants will show high levels of adherence (25 or more sessions of neurofeedback) to the NeuroSky + Cortex EEG intervention for the 3-month study duration and that participants will show statistically significant reduction in pain symptoms at 3 months compared to baseline. Given links between pain and other outcomes in veterans, we will also explore effects on drug abuse, violence, and suicidality. When the research is complete, the field will be changed because we will know whether new technology reading EEG brainwaves can be used to treat symptoms among individuals suffering from chronic pain. We will also know whether neurofeedback shows promise as an effective intervention for veterans with PTSD and TBI to reduce pain and related outcomes. If these benchmarks are achieved, the R34 will lay the groundwork for a future, large scale randomized clinical trial employing objective neuroimaging and physiological measures to pinpoint mechanisms underlying reduced pain from the intervention and to determine whether improvement persists long term. If this program of research is successful, its impact will be to shift approaches to managing pain in clinical practice, for both veterans and civilians.

描述(申请人提供)：多达一半患有创伤性脑损伤(TBI)的退伍军人同时患有创伤后应激障碍(PTSD)。两者都与较高的慢性疼痛风险有关，这是参加过持久自由行动(阿富汗)、伊拉克自由行动(伊拉克)和新黎明行动(OEF/OIF/OND)的美国退伍军人中最常见的健康问题之一。然而，止痛药会增加阿片类药物滥用的风险，研究表明，退伍军人认为传统的心理健康治疗存在障碍。很少有关于非药理学的、基于技术的干预措施的研究，这些干预措施旨在减轻患有创伤后应激障碍和脑外伤的退伍军人的疼痛。用于实施神经反馈(脑电生物反馈)的移动技术在提供便携的、低成本的干预措施方面显示出希望，以减少患有共生疾病的退伍军人的疼痛。在目前的R34中，我们的目标是测试使用移动神经反馈设备来减轻患有创伤后应激障碍和脑外伤的退伍军人疼痛症状的可行性和有效性。N=100名患有创伤后应激障碍、脑外伤和慢性疼痛的OED/OIF/OND退伍军人将收到一款NeuroSky耳机(可读取脑电脑波)和一款带有名为“Cortex EEG”的应用程序的iPod Touch(提供神经反馈以诱导生理放松)。NeuroSky和Cortex EEG通过蓝牙连接在一起，退伍军人被教导如何一起使用它们来进行神经反馈。在工作人员的帮助下，退伍军人还将在iPod日历上输入时间表和提醒，在家中或其他首选的环境中自己练习神经反馈，为期12周，每天20分钟，每周4次。将收集干预前后的全面数据。在此期间，我们将在APP上收集数据 通过电话进行两次使用，并进行家访，练习神经反馈，排除技术问题，并收集关于使用的数据。在现有研究和初步数据的指导下，我们假设，在为期3个月的研究期间，80%的参与者将表现出对NeuroSky+Cortex EEG干预的高度坚持(25次或更多次神经反馈)，并且参与者在3个月时疼痛症状将比基线显著减少。鉴于退伍军人的疼痛和其他结果之间的联系，我们还将探索对药物滥用、暴力和自杀的影响。当研究完成后，这一领域将发生变化，因为我们将知道读取脑电脑波的新技术是否可以用于治疗慢性疼痛患者的症状。我们还将知道神经反馈是否显示出对患有创伤后应激障碍和创伤性脑损伤的退伍军人进行有效干预以减少疼痛和相关结果的前景。如果达到这些基准，R34将为未来采用客观的大规模随机临床试验奠定基础 神经成像和生理测量，以查明干预减轻疼痛的潜在机制，并确定改善是否长期持续。如果这个研究项目成功，它的影响将是改变临床实践中控制疼痛的方法，无论是退伍军人还是平民。

项目成果

Chronic Pain, TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses?

• DOI: 10.1016/j.jpain.2018.02.012
• 发表时间: 2018-07-01
• 期刊: JOURNAL OF PAIN
• 影响因子: 4
• 作者: Blakey, Shannon M.;Wagner, H. Ryan;Elbogen, Eric B.
• 通讯作者: Elbogen, Eric B.

Risk factors for concurrent suicidal ideation and violent impulses in military veterans.

退伍军人并发自杀意念和暴力冲动的危险因素。

• DOI: 10.1037/pas0000490
• 发表时间: 2018
• 期刊: Psychological assessment
• 影响因子: 3.6
• 作者: Elbogen,EricB;Wagner,HRyan;Kimbrel,NathanA;Brancu,Mira;Naylor,Jennifer;Graziano,Robert;Crawford,Eric;VAMid-AtlanticMIRECCWorkgroup
• 通讯作者: VAMid-AtlanticMIRECCWorkgroup