Delivering a Mobile and Web Based Self Directed Complementary And Integrative Health Program to Veterans and Their Partners to Manage Pain and PTSD

慢性疼痛是退伍军人中最常见的疾病之一。疼痛 常伴有并发症，尤其是创伤后应激障碍(PTSD)。 合并慢性疼痛和创伤后应激障碍显著影响退伍军人及其家属的生活质量 家人。利用互补和综合健康(CIH)的多方面治疗 退伍军人管理局授权补充临床实践指南，提高退伍军人的生活质量和 发挥作用的能力。这项研究将评估CIH干预治疗疼痛和创伤后应激障碍的效果 生物-心理-社会框架内的结果。拟议的干预措施，特派团重新连接 (MR)，这是一个由用户驱动的二元式自助管理程序，通过在线和移动应用程序提供 这在以前已经被证明在非临床定义的基于社区的 退伍军人/军人。这项研究需要测试MR在临床上定义的 将人口作为临床服务的补充，以评估潜在的后续实施 在退伍军人事务部(VA)。 这项重新提交的提案是对退伍军人对CIH和几个 退伍军人管理局倡议，包括RR&D目前对非药理活动感兴趣的特殊领域- 针对影响疼痛减轻、功能和生活质量的慢性疼痛的干预措施。退伍军人事务部 卫生部长的战略优先事项和新兴的退伍军人事务部整体健康计划确定 获得CIH的疼痛和自我护理管理作为优先事项，以实现最佳退伍军人健康。 为响应这些优先事项，2016年退伍军人事务部最新技术会议(SOTA)和 《全面戒毒法》(CARA)要求退伍军人事务部承诺严格执行 研究将非药物和CIH方法整合到护理中，重点是疼痛 管理层。这项建议也是对退伍军人管理局的阿片类药物安全倡议(OSI)和疼痛的回应 护理使命，优先考虑疼痛的非药物治疗选择的需要。这个 本研究的短期目标是确定MR对(1)慢性疼痛、创伤后应激障碍和 相关结果和(2)退伍军人及其伴侣的关系结果。长期的 目标是确定使用CIH自我护理管理的有效性和可持续性 像MR这样的计划，以改善患有慢性疼痛和创伤后应激障碍的退伍军人的预后，以及他们的 合伙人。我们提出了一项为期四年的双臂MR的混合方法随机对照试验 (治疗和等待名单对照)在患有疼痛和创伤后应激障碍的退伍军人的临床样本中，以及 他们的伴侣(例如，配偶)。具体目标是：(目标1)确定MR的有效性 生理(疼痛、睡眠)、创伤后应激障碍(侵扰、唤醒、回避、麻木)和心理 (抑郁、压力、焦虑)症状和全球健康(生活质量)；(目标2)确定MR 对社会结果的有效性(关系满意度，对自己/他人的同情) 退伍军人和他们的合作伙伴；以及(目标3)描述退伍军人和合作伙伴在 参与者的次级样本。样本将由资深和合作伙伴二元组(N=228)组成 安娜堡、普吉特湾和坦帕弗吉尼亚州设施。AIM 1和2的数据收集将包括自我报告 在4个月内评估4个数据点，以评估身体、心理和社交能力 结果。还将收集8份周报，供MR使用的前两个月进行评估 MR利用率，以及疼痛和压力水平。AIM 3的数据收集将包括电话采访 从随机选择的MR治疗组DYADS(n=42)的子样本中检查MR用户 经验和他们的建议使MR对退伍军人和他们的合作伙伴有用。

Chronic pain is one of the most prevalent medical conditions in the Veteran population. Pain often presents with comorbid conditions, specifically post-traumatic stress disorder (PTSD). Comorbid chronic pain and PTSD significantly impact the quality of life of Veterans and their families. Multi-faceted therapies leveraging complementary and integrative health (CIH) are mandated within VA to complement clinical practice guidelines improve Veterans' quality of life and ability to function. This research will evaluate a CIH intervention to manage pain and PTSD related outcomes within a bio-psychosocial framework. The proposed intervention, Mission Reconnect (MR), a user-driven, dyadic, self-care management program delivered online and by mobile app that has previously shown to be effective in a non-clinically defined community-based Veteran/military population. This research is needed to test MR's effects in a clinically defined population as a complement to clinical services to assess for potential subsequent implementation within the Department of Veterans Affairs (VA). This proposal resubmission is responsive to Veterans' reported desire for CIH and several VA initiatives, including RR&D's current special areas of interest for non-pharmacological activity- based interventions for chronic pain impacting pain reduction, function and quality of life. The VA Secretary of Health Strategic Priorities and the emerging VA Whole Health Program identify access to CIH for pain and self-care management as a priority to achieve optimal Veteran health. To be responsive to these priorities the 2016 VA State-of-the-Art Conference (SOTA) and Comprehensive Addiction Recovery Act (CARA) mandated VA's commitment to conduct rigorous research to integrate non-pharmacological and CIH approaches into care, with emphasis on pain management. This proposal is also responsive to the VA's Opioid Safety Initiative (OSI) and Pain Care Mission which prioritize the need for nonpharmacological treatment options for pain. The short-term goal of this study is to determine the effects of MR on (1) chronic pain, PTSD and related outcomes and (2) relationship outcomes for Veterans and their partners. The long-term goal is to determine the effectiveness and sustainability of using CIH self-care management programs like MR to improve outcomes for Veterans with chronic pain and PTSD, and their partners. We propose a four-year mixed-methods randomized controlled trial of MR with two arms (treatment & wait-list control) in a clinical sample of Veterans with comorbid pain and PTSD, and their partners (e.g., spouse). The specific aims are to: (Aim 1) Determine MR effectiveness for physical (pain, sleep), PTSD (intrusion, arousal, avoidance, numbing), and psychological (depression, stress, anxiety) symptoms, and global health (quality of life); (Aim 2) Determine MR effectiveness for social (relationship satisfaction, compassion for self/others) outcomes among Veterans and their partners; and (Aim 3) Describe Veteran and partner perceived value of MR in a sub-sample of participants. The sample will consist of Veteran and partner dyads (N = 228) at the Ann Arbor, Puget Sound, and Tampa VA facilities. Aim 1 & 2 data collection will include self-report assessment of 4-data points over a 4-month period to evaluate physical, psychological, and social outcomes. Eight weekly reports will also be collected for the first two months of MR use to assess MR utilization, and pain and stress levels. Aim 3 data collection will include telephone interviews from a randomly selected sub-sample of MR treatment group dyads (n = 42) to examine MR user experiences and their suggestions making MR useful for Veterans and their partners.