Collaborative Care for Veterans with Spine Pain and Mental Health Conditions

为患有脊柱疼痛和心理健康问题的退伍军人提供协作护理

• 批准号: 8758441
• 负责人: christine MARIE goertz
• 金额: $ 23.09万
• 依托单位: PALMER COLLEGE OF CHIROPRACTIC
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8758441
• 关键词: Address; Advisory Committees; Alternative Therapies; Analgesics; Anxiety; Back Pain; Caring; Clinical Practice Guideline; Clinical Trials; Comorbidity; Complementary and alternative medicine; Complementary therapies; Complex; Consensus; Department of Defense; Development; Doctor of Chiropractic; Effectiveness; Emotional; Evaluation; Future; Guidelines; Headache; Health; Health Services; Healthcare; Intervention; Investigation; Knowledge; Literature; Medical Research; Mental Depression; Mental Health; Mental disorders; Methods; Military Personnel; Modality; Modeling; Musculoskeletal; Musculoskeletal Diseases; Musculoskeletal Pain; Neck Pain; Opioid; Outcome; Pain; Pain management; Pathway interactions; Patients; Pharmaceutical Preparations; Phase; Population; Post-Traumatic Stress Disorders; Process; Productivity; Protocols documentation; Quality of life; Randomized Controlled Trials; Reporting; Research Proposals; Risk; Role; Safety; Services; Staging; Testing; United States National Institutes of Health; Vertebral column; Veterans; Work; aged; arm; base; chiropracty; chronic pain; collaborative care; disability; health administration; multidisciplinary; narcotic overdose; physical conditioning; programs; public health relevance; screening; standard care; therapy design; treatment program

DESCRIPTION (provided by applicant): US military veterans report very high levels of musculoskeletal (MSK) pain, including back pain, neck pain, and headache and have high rates of many mental health conditions, such as depression, anxiety, post-traumatic stress disorder (PTSD), often co-occurring with MSK pain. Veterans who have painful conditions often report high analgesic and prescription medication use, including opioids. The combination of MSK pain, mental health conditions, and frequent analgesic use is a rising concern in terms of disability, work productivity, quality of life and the risk of overuse and overdose from narcotics. Veterans often use complementary and alternative therapies (CAM), including chiropractic, for MSK complaints mental health concerns. However, few studies have addressed the role of chiropractic care for veterans within Veterans Health Administration (VHA) settings, or how such services might be integrated seamlessly into existing VHA clinical practice guidelines, physical and mental health screening and treatment programs or pain management approaches. To address this gap in health services, we propose a mixed-methods approach to develop integrative care pathways for the care of veterans with co-morbid musculoskeletal pain and anxiety, depression or PTSD. We will accomplish the following four Aims: Specific Aim 1: Develop an integrative care model that includes doctors of chiropractic in multidisciplinary teams treating patients with MSK pain and mental health co-morbidities in the VHA, based on the COCOA model; Specific Aim 2: Tailor existing chiropractic guidelines and best practices to interlink with current VHA pain management initiatives through a consensus building process; Specific Aim 3: Conduct a one-arm pilot clinical trial of this integrative care model including doctors of chiropractic in 20 veterans aged 55 and older with MSK pain and mental health co-morbidities to assess the feasibility, acceptability, safety, tolerability and target outcomes for future randomized controlled trial; Specific Aim 4: Revise the study protocol based upon pilot findings and submit a competitive research proposal for a fully-powered effectiveness study to NIH at the end of the study period. In summary, the Veterans Health Administration (VHA) has implemented progressive programs for both pain and mental health management. However, a gap exists in our knowledge of the effectiveness of integrative treatments including CAM added to existing pain management strategies for veterans with mental health co-morbidities. Chiropractic is one CAM treatment that has demonstrated its evidence of efficacy and safety in the treatment of MSK disorders, and the DoD/VA Pain Management Task Force comprehensive pain management program includes chiropractic as a Tier 1 treatment modality. However, the appropriate role for chiropractic in veteran populations, especially those with MSK pain and mental health disorders, requires further investigation.

描述（由申请人提供）：美国退伍军人报告非常高水平的肌肉骨骼（MSK）疼痛，包括背痛，颈部疼痛和头痛，并且具有许多精神健康状况的高比率，例如抑郁，焦虑，创伤后应激障碍（PTSD），通常与MSK疼痛共同发生。有疼痛症状的退伍军人经常报告使用高镇痛药和处方药，包括阿片类药物。MSK疼痛、心理健康状况和频繁使用镇痛药的组合在残疾、工作效率、生活质量以及麻醉剂过度使用和过量使用的风险方面日益受到关注。 退伍军人经常使用补充和替代疗法（CAM），包括脊椎按摩疗法，来解决精神健康问题。然而，很少有研究涉及脊椎按摩护理在退伍军人健康管理局（VHA）环境中对退伍军人的作用，或者这些服务如何无缝集成到现有的VHA临床实践指南，身心健康筛查和治疗计划或疼痛管理方法中。为了解决卫生服务中的这一差距，我们提出了一种混合方法的方法来开发综合护理途径，用于护理患有共病肌肉骨骼疼痛和焦虑，抑郁或创伤后应激障碍的退伍军人。我们将实现以下四个目标：具体目标1：基于可可模型，开发一种综合护理模式，包括多学科团队中的脊椎指压治疗医生，治疗VHA中患有MSK疼痛和精神健康共病的患者;具体目标2：通过建立共识的过程，定制现有的脊椎指压治疗指南和最佳实践，以与当前的VHA疼痛管理计划相互联系;具体目标3：在20名55岁及以上患有MSK疼痛和精神健康共病的退伍军人中进行这种综合护理模式的单臂试点临床试验，以评估未来随机对照试验的可行性、可接受性、安全性、耐受性和目标结局;具体目标4：根据试点结果修改研究方案，并在研究期结束时向NIH提交一份全面有效性研究的竞争性研究提案。总之，退伍军人健康管理局（VHA）已经实施了疼痛和心理健康管理的渐进式计划。然而，我们对综合治疗有效性的认识存在差距，包括CAM添加到现有的疼痛管理策略中，用于患有精神健康共病的退伍军人。脊椎按摩疗法是一种CAM治疗方法，已证明其在治疗MSK疾病方面的有效性和安全性，DoD/VA疼痛管理工作组全面的疼痛管理计划将脊椎按摩疗法列为一级治疗方式。然而，脊椎按摩疗法在退伍军人群体中的适当作用，特别是那些患有MSK疼痛和精神健康障碍的人，需要进一步调查。