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 不成比例地受到影响。疼痛和创伤后应激障碍共同发生的频率和程度， 和创伤性脑损伤（TBI），所有三种情况（展开后多症状 精神分裂症（PMD）和其他多症状综合征可以使患者的症状复杂化并减少其症状。 疼痛治疗的有效性。 此外，大多数退伍军人不寻求护理在VA 设置，需要一个方法，将提供给所有退伍军人。缓解的蓝图 美国疼痛和国家疼痛战略呼吁促进自我管理;减少 弱势群体之间的差距（例如，#21453;，以及对疼痛的护理。 支持者的综合治疗常见的共病条件是主张 针对多种情况的干预措施。第二阶段的建议建立在一个成功的 NACTS资助的第一阶段SBIR开发和试点测试了一个理论上有基础的，移动的- 优化，互动疼痛自我管理干预退伍军人慢性 肌肉骨骼疼痛健康eRide：您的疼痛管理之旅1）是专门定制的 退伍军人的准备和疼痛自我管理的首选策略; 2）利用短信 消息传递、社交网络和游戏原则，以提高参与度和保留率;以及 3)帮助解决创伤后应激障碍和创伤性脑损伤的共同发生，包括健康行为的改变， 睡眠卫生和压力管理的信息。在30天随访时，参与者（n=44） 报告称疼痛和疼痛影响显著减少， 自我管理策略。超过68%的参与者表示， 变化第二阶段将涉及1）通过改造完成Health eRide的开发， 并增强其在移动的浏览器中的功能，增强社交 网络和游戏功能，并增加电子教练能力; 2）进行一年- 一项长期随机试验，从两个VA机构招募了540名慢性疼痛退伍军人 和社区被随机分配到健康eRide或在线教育认知- 行为治疗干预将检查疼痛强度和干扰的差异 6个月（干预后即刻）和12个月。一些次要分析 将进行检查健康eRide对其他结果的影响（例如，PTSD 症状）。一次成功的试验将为广泛传播一种有效的， 易于获得的定制疼痛自我管理干预，以解决 我们国家的退伍军人以及适应一般成年人口。

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.