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

慢性肌肉骨骼疼痛造成了重大的公共卫生负担，退伍军人 受到不成比例的影响。疼痛与创伤后应激障碍、疼痛同时出现的频率和程度 和创伤性脑损伤(TBI)，所有三种情况(部署后多症状 精神障碍(PMD)和其他多症状综合征会使 疼痛治疗的有效性。 此外，大多数退伍军人没有在退伍军人管理局寻求护理 设置，需要一种可供所有退伍军人使用的方法。缓解的蓝图 美国的痛苦和国家痛苦战略呼吁促进自我管理；减少 弱势群体(如退伍军人)之间的差异；以及疼痛护理的量身定做。 支持综合治疗常见合并症的人主张 针对多种情况的干预措施。此第二阶段提案建立在一个成功的 NACTS资助的第一阶段SBIR开发和试点测试了理论上站稳脚跟的移动- 优化的交互式疼痛自我管理干预对慢性退伍军人的影响 肌肉骨骼疼痛。健康eRide：您的疼痛管理之旅是专门为您量身定做的 对退伍军人进行疼痛自我管理的准备情况和首选策略；2)利用短信 消息传递、社交网络和游戏原则，以提高参与度和留存率；以及 3)通过纳入健康行为改变，帮助解决创伤后应激障碍和创伤后应激障碍的并存问题 关于睡眠卫生和压力管理的信息。在30天的随访中，参与者(n=44) 报告显著降低了痛苦和痛苦影响，并提高了部署 自我管理战略。超过68%的参与者表示在全球范围内对 变化。第二阶段将包括1)通过对Health eRide进行改造来完成其开发 集成到应用程序中，并增强其针对移动浏览器的功能，增强社交 网络和游戏功能，并增加电子教练功能；以及2)开展一年- 从退伍军人管理局和退伍军人管理局招募的540名患有慢性疼痛的退伍军人参加的长期随机试验 和社区被随机分配到Health eRide或在线教育认知- 行为疗法干预。将检查疼痛强度和干扰的差异 6个月(干预后立即)和12个月。一些二次分析 将检查Health eRide对其他结果(例如，创伤后应激障碍)的影响 症状)。成功的试验将为广泛传播一种有效的、 易于获取的量身定制的疼痛自我管理干预，以解决以下紧急需求 我们国家的退伍军人以及普通成年人的适应。

Chronic musculoskeletal pain creates a significant public health burden, and Veterans are disproportionately affected. The frequency and extent of co-occurrence of pain and PTSD, pain and Traumatic Brain Injury (TBI), all three conditions (Post-deployment Multi-symptom Disorder (PMD), and other multi-symptom syndromes can complicate and reduce the effectiveness of pain treatment. Furthermore, the majority of Veterans do not seek care in VA settings, requiring an approach that will be available to all Veterans. The Blueprint for Relieving Pain in America and National Pain Strategy call for the promotion of self-management; reducing disparities among vulnerable subgroups (e.g., Veterans); and the tailoring of pain care. Proponents of integrated treatment for common co-morbid conditions are advocating for interventions that address multiple conditions. This Phase II proposal builds on a successful NACTS-funded Phase I SBIR that developed and pilot tested a theoretically-grounded, mobile- optimized, interactive pain self-management intervention for Veterans with chronic musculoskeletal pain. Health eRide: Your Journey to Managing Pain 1) was tailored specifically to Veterans' readiness and preferred strategies for pain self-management; 2) leveraged SMS messaging, social networking, and gaming principles to increase engagement and retention; and 3) helped to address the co-occurrence of PTSD and TBI by including health behavior change messages for sleep hygiene and stress management. At 30-day follow-up, participants (n=44) reported significant reductions in pain and pain impact, as well as increased readiness to employ self-management strategies. Over 68% of participants reported favorable global impression of change. Phase II will involve 1) completing the development of Health eRide by transforming it into an app and enhancing its functionality for mobile browsers, enhancing the social networking and gaming features, and adding e-coaching capabilities; and 2) conducting a year- long randomized trial in which 540 Veterans with chronic pain recruited from both VA facilities and the community are randomly assigned to Health eRide or an online educational cognitive- behavioral therapy intervention. Differences in pain intensity and interference will be examined at 6 months (immediately post-intervention) and 12-months. A number of secondary analyses will be conducted to examine the impact Health eRide has on other outcomes (e.g., PTSD symptoms). A successful trial will set the stage for widespread dissemination of an efficacious, easily accessible tailored pain self-management intervention to address an urgent need among our nation's Veterans as well as an adaptation for general adult populations.