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中很常见，精明的康复计划对于避免有害的 功能结局和其他生活质量（QoL）的结局。疼痛后获得最佳功能结局 然而，在相当一部分残疾源于“非器质性”的情况下，康复是具有挑战性的。 心理因素主要由心理驱动因素造成的残疾会使退伍军人成为穷人 侵入性医疗程序的候选人（其益处和潜在危害最小）。非有机 传统上使用临床医师评定的“Waddell体征”来探测疼痛。然而，这些迹象并不一致。 探索，评估者间可靠性可疑，在VHA中可能具有挑战性，其中症状认可 可以在财政上加强。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。该项目是一个概念验证研究，以确定 对疼痛的潜意识偏见，如疼痛相关刺激引起的注意力捕捉，是否与情绪相关 入院时心理驱动残疾的康复学和临床医生印象，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个月的时间里，50名退伍军人将参加 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的评估 将从电子病历（EMR）中识别具有最小疼痛史的预约（例如，初级护理） 并在他们的入学预约之前接近，并被邀请完成约90分钟的评估电池， 便携式触摸屏平板电脑，无论是在他们的家或在VAMC。该电池将由 基于访谈的疼痛康复学和残疾（如职业功能），情感 神经病学和生活质量，以及对疼痛的潜意识偏见的神经认知任务的表现- 相关概念/单词和疼痛相关图像。冲动和挫折容忍度的比较任务将 也包括在内。该评估将以患者对负担或厌恶程度的评级结束 评估本身。评估后六个月，参与者将通过电话 在基线时对患者进行疼痛症状、疼痛功能障碍和生活质量评估。除了核心 为了探索计算机化偏倚评估在慢性疼痛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潜意识疼痛偏差的差异，以及2）疼痛和非疼痛患者之间的相关性。 基线时的潜意识偏差和情绪/疼痛/残疾/QoL症状评分，以评估 探索疼痛患者的潜意识偏见作为增值补充分析，我们将：1） 评估项目（包括偏见任务和访谈工具评分），以沃德尔评级的摄入临床医生指出， 在EMR中，2）将注意力（内隐）偏差评分与随访时疼痛和残疾评级相关联。后续MERIT 项目：许多表现出心理驱动残疾迹象的退伍军人不愿意采用提供者 建议寻求综合精神卫生保健。为了帮助提供者激励这些患者， MERIT研究将收集证据，证明患有心理驱动疼痛残疾的退伍军人选择性受益 从环绕式的精神健康护理中解脱出来最强的神经行为标志物（自我报告和临床医生- 从笔记本电脑评估的这个I21项目将被移植到一个移动的应用程序测试 一个全面观察性研究的平台，旨在显示app（任务）结果是否可预测疼痛 治疗结果，作为是否利用精神卫生服务的函数。这些数据将使 测试应用程序返回实际的偏见“风险”分数给病人和提供者。在随后的临床试验中， 风险评分，我们将比较心理风险评分为（一项研究 臂）vs（另一臂）不可用于提供者的治疗计划。康复结果， 将跟踪并比较各组之间的整体QoL和疼痛评分，作为（相互作用）的函数 与）应用程序标记（可能的非器质性疼痛）的情况下，是否给予综合心理健康服务。