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: 10254010
• 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 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254010
• 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; Healthcare; 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和精明的康复计划中很常见，至关重要 功能结果和其他生活质量的结果（QOL）。疼痛后达到最佳功能结果 但是，在“无机” 心理因素。主要的心理驱动因素的残疾将使退伍军人成为穷人 侵入性医疗程序的候选人（这将具有最小的福利和潜在危害）。无机 传统上，使用临床评级的“ Waddell标志”探测了疼痛。但是，这些迹象不一致 探测，具有可疑的评估者间可靠性，可以在VHA中受到挑战，其中症状认可 可以在财务上加强。因此，迫切需要一个时间敏感，难以启用的目标标记 用于治疗计划的心理驱动的残疾。该项目是概念验证研究，以确定 潜意识偏见是否对疼痛（例如与疼痛相关刺激的注意力捕获）是否与情绪相关 摄入时心理驱动的残疾的症状和临床印象，探索性目的 将偏见指标与疼痛治疗结果相关的。方法：在15个月的时间内，有50名退伍军人计划 在VA医疗中心（VAMC）疼痛诊所的评估和30名“对照”退伍军人定于非生气有关 将从电子病历（EMR）中确定的任命（例如初级保健）（例如初级保健） 并在预约之前接近，并邀请完成约90分钟的评估电池 便携式触摸屏tablet-PC，无论是在他们的家中还是在VAMC中。该电池由 基于面试的疼痛症状和残疾手段（例如，占领功能），情感 症状和质量学以及潜意识偏见对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。冲动和挫败感的比较器任务将 也包括在内。该评估将包括患者对烧伤或厌恶性的评级 评估本身。评估后六个月，参与者将通过电话重复 访谈基线探测的疼痛症状，疼痛障碍和QOL评估项目。除了核心 探测计算机偏见评估在患有慢性疼痛的退伍军人中的可行性，分析将测试 对于：1）疼痛和非疼痛患者之间的潜意识疼痛偏见的差异，以及2） 潜意识偏见和情绪/疼痛/残疾/QOL症状分数在基线时评估核心有效性 探测疼痛患者的潜意识偏置度量。作为增值补充分析，我们将：1）联系 评估项目（包括偏差任务和访谈工具分数），以纳德尔的临时医生评级 在EMR中，2）将注意力（隐式）偏置分数与随访时的疼痛和残疾评分联系起来。后续功绩 项目：许多表现出心理驱动的残疾迹象的退伍军人不愿采用提供者 寻求综合心理保健的建议。为了帮助提供者激励这些患者，跟进 优异研究将收集证据表明，具有心理疼痛障碍的退伍军人有选择地受益 来自环绕的心理保健。强烈的神经行为标记（自我报告和临床 该I21项目的笔记本电脑评估中的评分心理困扰将移植到移动应用测试中 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 治疗结果是是否利用了精神卫生服务。这些数据将使 测试应用程序以将实际偏见“风险”分数归还给患者和提供者。在随后对应用程序的临床试验中 风险评分，我们将比较当心理风险等级时的功能康复结果（一项研究） ARM）VS不能（其他ARM）提供治疗计划。以 将跟踪整个QOL和疼痛症状学，并在组之间进行比较（相互作用） ）是否给予综合心理健康服务（可能是非有机疼痛）病例。