Longitudinal Mixed Method Study of Chronic Pain, PTSD, & CAM in OEF/OIF Veterans

慢性疼痛、创伤后应激障碍 (PTSD) 的纵向混合方法研究

• 批准号: 8752688
• 负责人: Erin Elizabeth Krebs
• 金额: $ 55.22万
• 依托单位: UNIVERSITY OF MINNESOTA
• 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 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8752688
• 关键词: Adult; Adverse event; Affect; Affective; Afghanistan; Anxiety; Attitude; Behavioral Model; Caring; Characteristics; Complementary and alternative medicine; Data; Data Set; Department of Defense; Development; Diagnosis; Distress; Dose; Freedom; Funding; Goals; Health; Health Services; Health system; Healthcare; Impairment; Individual; Intervention; Interview; Iraq; Knowledge; Longitudinal Studies; Mental Depression; Mental Health; Methods; Modeling; Opioid; Opioid Analgesics; Outcome; Pain; Pain interference; Pain management; Patients; Pattern; Personality; Phase; Population; Post-Traumatic Stress Disorders; Predictive Factor; Prevention; Research; Soldier; Substance Use Disorder; Substance abuse problem; Surveys; Testing; Veterans; War; chronic pain; cohort; cost; design; evidence base; experience; health care service utilization; high risk; holistic approach; improved; innovation; operation; patient oriented; preference; prospective; public health relevance; resilience; response; theories; therapy development

DESCRIPTION (provided by applicant): Chronic pain is a prevalent, debilitating, and costly national health problem. Nearly half of OEF/OIF Veterans receiving VA health care have at least one documented pain-related diagnosis, yet this high risk population remains understudied. Veterans with chronic pain and co-morbid mental health conditions, especially PTSD, are more likely to receive opioids for pain, to receive higher-dose opioids, and to experience opioid-related adverse events. Thus, it is imperative to better understand how post-deployment PTSD and other mental health problems as well as broad predisposing vulnerability factors such as personality might contribute to the development of chronic pain outcomes and influence health services utilization for pain management. There is also an urgent need to obtain a deeper understanding of OEF/OIF Veterans' perspectives on pain management to develop interventions that promote a patient-centered model of care emphasizing a holistic approach to pain management, including integration of evidence based complementary and alternative medicine (CAM) and other non-pharmacological pain management approaches. The long-term objective of this project is to improve pain management and reduce opioid-related harms for OEF/OIF Veterans with chronic pain and co-morbid mental health conditions. The primary goal of this proposal is to develop a comprehensive model for understanding the development of chronic pain outcomes, utilization of CAM and other non-pharmacological approaches, and utilization of opioid analgesics for chronic pain as well as gain a deeper understanding of Veterans' preferences and attitudes towards pain management approaches. Specific aims are to: 1) Identify predictors of chronic pain among OEF/OIF National Guard Veterans; 2) Characterize patterns of use of CAM, other non-pharmacological pain management approaches, and opioid analgesics; 3) Test a model of health services utilization that identifies prospectively assessed predisposing individual characteristics; facilitators and barriers; and need factors predictive of OEF/OIF Veterans' utilization of CAM, other non-pharmacological approaches, and opioid analgesics; and 4) Identify potential strategies for influencing OEF/OIF Veterans' use of CAM and other non-pharmacological approaches by gaining a richer understanding of patients' experiences with chronic pain and perspectives on pain management health services. The proposed project will capitalize on an existing longitudinal dataset that prospectively assessed 3,458 National Guard Soldiers prior to OEF/OIF deployments (2006-2010) and re-assessed Veterans across post-deployment waves. The current proposal utilizes a multi-phase, mixed methods design guided by an innovative conceptual framework integrating personality theory, a vulnerability-resilience model of chronic pain, and the Andersen Behavioral Model of Health Services Use. It will extend the existing longitudinal cohort by adding an additional wave of quantitative data focused on chronic pain outcomes and in-depth qualitative data examining Veteran perspectives on chronic pain and pain management health services.

描述（由申请人提供）：慢性疼痛是一种普遍的、使人衰弱的、代价高昂的全国性健康问题。近一半接受VA医疗保健的OEF/OIF退伍军人至少有一种与疼痛相关的诊断，但这一高风险人群仍未得到充分研究。患有慢性疼痛和共病精神健康状况的退伍军人，特别是PTSD，更有可能接受阿片类药物治疗疼痛，接受更高剂量的阿片类药物治疗，并经历与阿片类药物相关的不良事件。因此，有必要更好地了解部署后创伤后应激障碍和其他心理健康问题，以及广泛的易感脆弱性因素，如人格，可能有助于慢性疼痛结局的发展，并影响健康服务对疼痛管理的利用。此外，迫切需要深入了解OEF/OIF退伍军人对疼痛管理的看法，以制定干预措施，促进以患者为中心的护理模式，强调疼痛管理的整体方法，包括基于证据的补充和替代医学（CAM）和其他非药物疼痛管理方法的整合。该项目的长期目标是改善患有慢性疼痛和共病精神健康状况的OEF/OIF退伍军人的疼痛管理和减少阿片类药物相关伤害。本课题的主要目标是建立一个全面的模型，以了解慢性疼痛结局的发展、CAM和其他非药物方法的使用以及阿片类镇痛药对慢性疼痛的使用，并更深入地了解退伍军人对疼痛管理方法的偏好和态度。具体目的是：1)确定OEF/OIF国民警卫队退伍军人慢性疼痛的预测因素；2)描述CAM、其他非药物疼痛管理方法和阿片类镇痛药的使用模式；3)测试一个卫生服务利用模型，该模型确定了前瞻性评估的易感个体特征；促进因素和障碍；预测OEF/OIF退伍军人使用CAM、其他非药物方法和阿片类镇痛药的需求因素；4)通过更丰富地了解患者的慢性疼痛经历和疼痛管理健康服务的观点，确定影响OEF/OIF退伍军人使用CAM和其他非药物方法的潜在策略。拟议的项目将利用现有的纵向数据集，该数据集在OEF/OIF部署（2006-2010）之前对3,458名国民警卫队士兵进行了前瞻性评估，并在部署后对退伍军人进行了重新评估。目前的提案采用了多阶段的混合方法设计，以一个创新的概念框架为指导，整合了人格理论、慢性疼痛的脆弱性-弹性模型和卫生服务使用的安德森行为模型。它将通过增加一波专注于慢性疼痛结果的定量数据和深入的定性数据来扩展现有的纵向队列，这些数据将检查退伍军人对慢性疼痛和疼痛管理健康服务的看法。