Feasibility of a Combined Neuromodulation and Yoga Intervention for Veterans with Mild Traumatic Brain Injury and Chronic Pain

对患有轻度创伤性脑损伤和慢性疼痛的退伍军人进行神经调节和瑜伽联合干预的可行性

• 批准号: 10734032
• 负责人: Amy Herrold
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10734032
• 关键词: Afghanistan; Behavior Therapy; Brain; Breathing Exercises; Chronic; Clinical; Clinical Practice Guideline; Clinical Trials; Cognition; Common Data Element; Complementary Health; Data; Foundations; Frequencies; Future; Goals; High Prevalence; Hospitals; Impairment; Integrative Medicine; Intervention; Interview; Iraq; Knowledge; Lead; Literature; Logistics; Manuals; Meditation; Mental Health; Military Personnel; Motor Cortex; National Institute of Neurological Disorders and Stroke; Nervous System Trauma; Neuronal Plasticity; Opioid; Outcome; Pain; Pain intensity; Pain interference; Participant; Patient Self-Report; Patients; Pattern; Persons; Pilot Projects; Prevalence; Quality of life; Randomized, Controlled Trials; Recommendation; Recreation; Rehabilitation Outcome; Research; Risk; Safety; Sample Size; Sampling; Services; Severities; Stretching; Structure; TBI treatment; Testing; Time; Transcranial magnetic stimulation; Traumatic Brain Injury; United States; Veterans; Yoga; acceptability and feasibility; chronic pain; chronic pain management; cohort; design; effective therapy; effectiveness evaluation; evidence base; implementation efforts; improved; mild traumatic brain injury; mindfulness; neurological rehabilitation; neuroregulation; non-opioid analgesic; novel; opioid epidemic; opioid therapy; opioid use disorder; pain outcome; pain reduction; painful neuropathy; physical conditioning; programs; psychoeducation; psychoeducational; repetitive transcranial magnetic stimulation; satisfaction; treatment effect; treatment-resistant depression; whole health

Over 340,000 people have incurred a mild traumatic brain injury (mTBI) as a result of the military conflicts in Iraq and Afghanistan. mTBI leads to a host of poor rehabilitation outcomes including impairments in cognition, physical health, and psychological health. These impairments among people with TBI lead to poor quality of life (QOL). Worsening this clinical picture, the prevalence of chronic pain is estimated to be 51.5% among civilians with TBI and 43.1-70% among Veterans with TBI. Opioids are used for treating chronic pain including among people with TBI. Thus, given the ongoing opioid epidemic in the United States, it is very timely to develop alter- native, non-pharmacologic treatments for chronic pain among Veterans with mTBI. Yoga is a promising activ- ity-based intervention for TBI and chronic pain. Yoga is an activity generally comprised of breathing exercises, gentle stretching, and meditation. Neuromodulation through transcranial magnetic stimulation (TMS) is a prom- ising non-invasive, non-pharmacological treatment for TBI and chronic pain. Intermittent theta burst stimulation (iTBS) is a type of patterned, excitatory TMS. iTBS can induce a window of neuroplasticity, making it ideally suited to boost the effects of treatments provided after it. Thus, iTBS shows promise to prime the brain for combined interventions and may magnify the impacts that these interventions would have when used alone, in order to boost outcomes. The purpose of this SPiRE project is to develop a novel, combined neuromodulation and yoga neurorehabilitation intervention for Veterans with mTBI and chronic pain, and to examine the inter- vention’s feasibility and acceptability. Using an existing, evidence-based, yoga program created specifically for people with TBI (LoveYourBrain Yoga), we will first develop a neurorehabilitation intervention that combines iTBS with yoga (iTBS+yoga), and then collect pilot data about its feasibility and acceptability. Aim 1 will de- velop a novel, combined iTBS+yoga neurorehabilitation intervention for Veterans with mTBI and chronic pain. Aim 2 will examine the feasibility and acceptability of the iTBS+yoga intervention for Veterans with mTBI and chronic pain. Aim 3 will gather preliminary data to provide the foundation for sample size and power considera- tions for a future clinical trial to examine the effectiveness of iTBS+yoga on Veterans’ quality of life, function and pain outcomes. The combined intervention will be provided in small group settings once a week for 6 weeks. iTBS will be administered immediately prior to the LoveYourBrain Yoga session. Emphasizing National Institute of Neurological Disorders and Stroke (NINDS) Traumatic Brain Injury Common Data Elements (TBI CDEs), we will collect preliminary outcome data related to quality of life, function and pain to inform a future Merit application, should the intervention prove feasible. This SPiRE project will directly benefit Veterans and VA Services by developing a new, non-pharmacological neurorehabilitation treatment for Veterans with mTBI and chronic pain in need of non-opioid treatment options. TMS is now offered at 30 VA hospitals nationwide for treatment-resistant depression, and yoga is among the complementary and integrative health programs being rolled out as a part of VAs nation-wide Whole Health implementation efforts, with classes offered through VA service lines such as recreational therapy. Therefore, should iTBS+yoga ultimately prove to be efficacious and effective, VA facilities will be well-poised to offer this treatment. A novel, activity-based, non-pharmacological treatment for Veterans with mTBI and chronic pain is of great need given the high prevalence of chronic pain, increased risk of opioid therapy, and increased risk of developing opioid use disorders.

由于军事冲突，34万多人遭受轻度创伤性脑损伤

项目成果

Feasibility of a Combined Neuromodulation and Yoga Intervention for Mild Traumatic Brain Injury and Chronic Pain: Protocol for an Open-label Pilot Trial.

• DOI: 10.2196/37836
• 发表时间: 2022-06-15
• 期刊: JMIR RESEARCH PROTOCOLS
• 影响因子: 1.7
• 作者: Krese, Kelly A.;Donnelly, Kyla Z.;Etingen, Bella;Pape, Theresa L. Bender;Chaudhuri, Sarmistha;Aaronson, Alexandra L.;Shah, Rachana P.;Bhaumik, Dulal K.;Billups, Andrea;Bedo, Sabrina;Wanicek-Squeo, Mary Terese;Bobra, Sonia;Herrold, Amy A.
• 通讯作者: Herrold, Amy A.