Mental Function And Quality Of Life With Chronic Pain

慢性疼痛的心理功能和生活质量

• 批准号: 10391343
• 负责人: James M Bjork
• 金额: --
• 依托单位: VA VETERANS ADMINISTRATION HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10391343
• 关键词: Adopted; Affect; Affective; Afghanistan; Aggressive behavior; Algorithms; Anxiety; Appointment; Attention; Attitude; Award; Back; Belief; Biological Markers; Biological Process; Brain Concussion; Caring; Chronic; Clinical Trials; Cognitive Therapy; Computerized Medical Record; Computers; Data; Disease; Distress; Economics; Employment; Endocrine; Frustration; Goals; Headache; Health Personnel; Home; Image; Immune response; Impulsivity; Individual; Individual Differences; Injury; Intake; Interview; Iraq; Laboratories; Lifting; Light; Low Back Pain; Measurement; Measures; Medical; Medical center; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Military Personnel; Modeling; Moods; Neuraxis; Neurocognitive; Neurologic Process; Non-Malignant; Observational Study; Occupational; Opioid; Outcome; Pain; Pain Clinics; Pain management; Participant; Patient Self-Report; Patients; Performance; Peripheral Nervous System; Persons; Physical therapy; Post-Traumatic Stress Disorders; Primary Health Care; Procedures; Provider; Psyche structure; Psychological Factors; Quality of life; Quality-of-Life Assessment; Reaction Time; Recommendation; Recording of previous events; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Research Design; Risk; Risk Factors; Roentgen Rays; Scanning; Semantics; Services; Stimulus; Subconscious; Substance abuse problem; Suicide; Suicide attempt; Symptoms; Tablets; Telephone Interviews; Temperament; Testing; Time; Training; Traumatic Brain Injury; Treatment outcome; United States; Veterans; arm; attentional bias; base; biopsychosocial; central sensitization; chronic pain; comorbidity; computerized; cost; disability; environmental stressor; follow-up; functional outcomes; implicit bias; impression; improved; instrument; interdisciplinary approach; laptop; mental function; mobile application; motivational enhancement therapy; musculoskeletal injury; neurobehavioral; neuropathology; pain patient; pain perception; pain rehabilitation; pain signal; pain symptom; portability; psychologic; psychological distress; recruit; rehabilitation research; routine practice; smartphone based assessment; stem; symptomatology; tool; touchscreen; treatment planning

Background: Chronic pain is common in Veterans and astute rehabilitation plans are critical to avoid deleterious outcomes for functional outcomes and other quality of life (QoL). Attaining optimal functional outcomes after pain rehabilitation is challenging, however, in cases when a significant portion of disability stems from “nonorganic” psychological factors. Disability from primarily psychologically-driven factors would make a Veteran a poor candidate for invasive medical procedures (which would have minimal benefit and potential harms). Nonorganic pain has been traditionally probed using clinician-rated “Waddell signs.” However, these signs are inconsistently probed, with questionable inter-rater reliability and can be challenging in the VHA wherein symptom endorsement can be financially reinforced. Therefore, there is a critical need for a time-sensitive, hard-to-feign objective marker of psychologically-driven disability for treatment planning. This project is a proof-of-concept study to determine whether subconscious bias toward pain, such as attentional capture by pain-related stimuli, correlates with mood symptomatology and clinician impressions of psychologically-driven disability at intake, with an exploratory aim of relating bias metrics to pain treatment outcomes. Approach: Over a 15-month period, 50 Veterans slated for assessment at a VA medical center (VAMC) pain clinic and 30 “control” Veterans slated for a non-pain-related appointment (e.g. Primary Care) with minimal pain histories will identified from electronic medical records (EMR) and approached prior to their intake appointment and invited to complete a ~90-minute assessment battery on a portable touchscreen-tablet-PC, either in their home or at the VAMC. This battery will be composed of interview-based instruments of pain symptomatology and disability (e.g. occupational function), affective symptomatology and QoL, as well as performance of neurocognitive tasks of subconscious bias toward pain- related concepts/words and pain-related images. Comparator tasks of impulsivity and frustration tolerance will also be included. This assessment will conclude with the patient making ratings of the burden or aversiveness of the assessments themselves. Six months following this assessment, participants will repeat by telephone interview the pain symptom, pain disability and QoL assessment items probed at baseline. In addition to the core goal of probing the feasibility of computerized bias assessment in Veterans with chronic pain, analyses will test for: 1) differences in subconscious pain bias between pain and non-pain patients, and 2) correlations between subconscious bias and mood/pain/disability/QoL symptom scores at baseline, to assess the core validity of probing subconscious bias measures in pain patients. As value-added supplemental analyses, we will: 1) relate assessment items (both bias tasks and interview instrument scores) to Waddell ratings of intake clinicians noted in EMR, 2) relate attentional (implicit) bias scores to pain and disability ratings at follow-up. Follow-on MERIT projects: Many Veterans who show signs of psychologically-driven disability are reluctant to adopt provider recommendations to seek integrative mental health care. To help providers motivate these patients, follow-on MERIT studies will collect evidence that Veterans with psychologically-driven pain disability selectively benefit from wrap-around mental health care. The strongest neurobehavioral markers (of self-reported and clinician- rated psychological distress) from the laptop assessment of this I21 project will be ported to a mobile app testing platform for a full-scale observational study designed to show whether app (task) results are predictive of pain treatment outcomes, as a function of whether mental health services were utilized. These data will enable the testing app to return actual bias “risk” scores to the patient and provider. In a subsequent clinical trial of the app’s risk score, we will compare functional rehabilitation outcomes when the psychological risk rating is (one study arm) vs is not (other arm) available to the provider for treatment planning. Rehabilitation outcomes in terms of whole QoL and pain symptomatology will be tracked and compared between groups as a function of (interaction with) whether app-flagged (probable-nonorganic pain) cases were given integrative mental health services.

背景：慢性疼痛在退伍军人中很常见，精明的康复计划对于避免有害的伤害至关重要 功能结果和其他生活质量 (QoL) 的结果。疼痛后获得最佳功能结果 然而，当很大一部分残疾源于“非器质性”时，康复就具有挑战性 心理因素。主要由心理驱动因素造成的残疾将使退伍军人成为穷人 侵入性医疗程序的候选者（其益处最小且潜在危害）。无机 传统上使用临床医生评定的“Waddell 体征”来探测疼痛。然而这些迹象并不矛盾 被调查，评估者间的可靠性值得怀疑，并且在症状认可的 VHA 中可能具有挑战性 可以在财政上得到加强。因此，迫切需要一种对时间敏感、难以伪造的客观标记 心理驱动的残疾的治疗计划。该项目是一项概念验证研究，旨在确定 潜意识对疼痛的偏见（例如通过与疼痛相关的刺激引起的注意力捕获）是否与情绪相关 入院时心理驱动残疾的症状学和临床医生印象，具有探索性目的 将偏差指标与疼痛治疗结果联系起来。方法：在 15 个月的时间内，计划对 50 名退伍军人进行培训 在 VA 医疗中心 (VAMC) 疼痛诊所和 30 名“对照”退伍军人进行非疼痛相关评估 将从电子病历 (EMR) 中识别出疼痛史最少的预约（例如初级保健） 并在入学预约之前联系并邀请他们完成约 90 分钟的评估 便携式触摸屏平板电脑，无论是在家里还是在 VAMC。该电池将由 基于访谈的疼痛症状学和残疾（例如职业功能）、情感工具 症状学和生活质量，以及潜意识偏向疼痛的神经认知任务的表现 相关概念/单词和与疼痛相关的图像。冲动性和挫折容忍度的比较任务将 也被包括在内。该评估将以患者对负担或厌恶程度进行评级作为结束 评估本身。评估结束后六个月，参与者将通过电话重复 访谈基线时探讨的疼痛症状、疼痛残疾和生活质量评估项目。除了核心之外 目的是探讨计算机化偏见评估对患有慢性疼痛的退伍军人的可行性，分析将测试 用于：1) 疼痛患者和非疼痛患者之间潜意识疼痛偏差的差异，以及 2) 之间的相关性 基线时的潜意识偏见和情绪/疼痛/残疾/生活质量症状评分，以评估以下内容的核心有效性 探索疼痛患者的潜意识偏见测量。作为增值补充分析，我们将：1）关联 评估项目（偏见任务和面试工具分数）对入院临床医生的 Waddell 评级进行了记录 在 EMR 中，2) 将注意力（内隐）偏差评分与随访时的疼痛和残疾评级相关联。后续优点 项目：许多表现出心理驱动残疾迹象的退伍军人不愿意收养提供者 寻求综合心理保健的建议。为了帮助提供者激励这些患者，后续 MERIT 研究将收集证据，表明患有心理驱动的疼痛残疾的退伍军人有选择地受益 来自全方位的心理保健。最强的神经行为标志物（自我报告和临床医生） 该 I21 项目的笔记本电脑评估中的额定心理困扰将被移植到移动应用程序测试 用于全面观察研究的平台，旨在显示应用程序（任务）结果是否可以预测疼痛 治疗结果，作为是否利用心​​理健康服务的函数。这些数据将使 测试应用程序，将实际偏差“风险”分数返回给患者和提供者。在该应用程序的后续临床试验中 风险评分，我们将比较心理风险评分为（一项研究 手臂）与（其他手臂）无法提供给提供者进行治疗计划。康复效果体现在 将跟踪整个生活质量和疼痛症状，并根据（交互作用）在组之间进行比较 与）应用程序标记的（可能非器质性疼痛）病例是否接受综合心理健康服务。