Adaptation of Mindfulness Training to Treat Chronic Pain in the Military

正念训练在军队中治疗慢性疼痛的应用

• 批准号: 8900972
• 负责人: Susan Gaylord
• 金额: $ 27.33万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8900972
• 关键词: Address; Adult; Afghanistan; Alcohols; Analgesics; Anxiety; Complement; Data; Empirical Research; Evidence based program; Fatigue; Feasibility Studies; Feedback; Focus Groups; Funding; Future; Health; Health Technology; Informal Social Control; Iraq; Lead; Life; Link; Medical; Medical center; Mental Depression; Military Personnel; Modality; Modeling; Nature; North Carolina; Online Systems; Opioid Analgesics; Outcome; Pain; Pain management; Participant; Perception; Persons; Pharmaceutical Preparations; Physical Function; Population; Post-Traumatic Stress Disorders; Process; Program Accessibility; Protocols documentation; Public Health; Quality of life; Randomized Controlled Trials; Recruitment Activity; Religion and Spirituality; Research; Research Personnel; Role; Services; Sleep disturbances; Sleeplessness; Societies; Soldier; Staging; Stress; Substance abuse problem; Symptoms; Terminology; Testing; Training; Trauma; Traumatic Brain Injury; Travel; Universities; Variant; Veterans; Work; addiction; alcohol misuse; chronic pain; coping; cost; disability; economic cost; efficacy trial; evidence base; experience; improved; mHealth; member; mindfulness; mindfulness-based stress reduction; mobile application; programs; psychologic; public health priorities; public health relevance; satisfaction; secondary outcome; skills; social stigma; usability

DESCRIPTION (provided by applicant): Chronic pain is a significant public health priority for society, including the military. This application will test the acceptability and feasibility of an interactive, web-based mindfulness training with active duty soldiers being treated for chronic pain. We will adapt the evidence-based Mindfulness-based Stress Reduction (MBSR) program for use with this population. The training will be enhanced by mobile applications (apps) for skill practice, using an existing apps platform. Study participants will be recruited from the Interdisciplinary Pain Management Center at Womack Army Medical Center (WAMC) in Fort Bragg, NC, one of eight IPMCs nationally whose work is setting the standard for the DoD through its interdisciplinary, holistic, and multimodal approach to pain management. Rates of chronic pain in the military are exceedingly high, ranging from 28% to 82%. Estimated disability and medical costs for Iraq and Afghanistan veterans range from $350 to $700 billion. Chronic pain in the military often co-occurs with depression, post-traumatic stress disorder, traumatic brain injury, and drug and alcohol misuse. MBSR has a well-established evidence base and is efficacious in reducing depression, anxiety, stress, insomnia, and substance abuse. MBSR is also effective in ameliorating pain symptoms. However, the military's unique context differs dramatically from the civilian setting. These variations impact the feasibility and acceptability o the standard MBSR training, underscoring need for a preliminary study that includes a skillful adaptation process, a pretest, and a pilot test, thus laying the groundwork for a larger efficacy trial. The specific aims of this study are as follows: Aim 1. Adapt the evidence-based MBSR program for the military and add apps to an existing platform to develop a preliminary protocol. Aim 2. Assess the usability of the web-based preliminary protocol and apps at an early, pretest stage (1 group; N=8) in order to manualize and create a test protocol; Aim 3. Test the feasibility and acceptability of the test protocol and apps (4-5 sequential groups; N=32-40). The mindfulness protocol will be delivered via an existing web-based platform that enhances program accessibility and reach. The apps will utilize an existing platform that was developed by a team member with DoD funding, thus saving costs; the DoD is highly supportive of its expanded use. The investigative team includes researchers with in-depth experience in mindfulness, adaptation of evidence-based programs, mobile health technology, and military health research. This acceptability and feasibility study has significant

描述(由申请人提供)：慢性疼痛是包括军队在内的社会的一个重要的公共卫生优先事项。此应用程序将测试可接受性和可行性 互动，基于网络的正念训练，现役士兵正在接受慢性疼痛的治疗。我们将调整基于循证正念的压力减轻(MBSR)计划，以适应这一人群。培训将通过使用现有应用程序平台的用于技能练习的移动应用程序(APP)来加强。研究参与者将从北卡罗来纳州布拉格堡的沃马克陆军医疗中心(WAMC)的跨学科疼痛管理中心招募，该中心是全国八家IPMC之一，其工作是通过其跨学科、整体和多模式的疼痛管理方法为国防部设定标准。军队中慢性疼痛的比率非常高，从28%到82%不等。据估计，伊拉克和阿富汗退伍军人的残疾和医疗费用从3500亿美元到7000亿美元不等。军队中的慢性疼痛通常与抑郁症、创伤后应激障碍、创伤性脑损伤以及药物和酒精滥用并存。MBSR有充分的证据基础，在减少抑郁、焦虑、压力、失眠和药物滥用方面有效。MBSR在改善疼痛症状方面也是有效的。然而，军方的独特背景与平民环境截然不同。这些变化影响了标准MBSR培训的可行性和可接受性，强调了初步研究的必要性，其中包括熟练的适应过程、预测测试和试点测试，从而为更大规模的疗效试验奠定了基础。本研究的具体目的如下：目的1.将循证医学医学研究计划应用于军事领域，并在现有平台上添加应用程序，以制定初步的实验方案。目的2.在早期、预试阶段(1组；N=8)评估基于网络的初步方案和APP的可用性，以使测试方案人性化并创建测试方案；目标3.测试测试方案和APP(4-5个顺序组；N=32-40)的可行性和可接受性。正念方案将通过现有的基于网络的平台交付，该平台增强了程序的可及性和覆盖范围。这些应用程序将利用由国防部资助的团队成员开发的现有平台，从而节省成本；国防部高度支持其扩大使用。调查团队包括在正念、循证计划改编、移动卫生技术和军事卫生研究方面具有深入经验的研究人员。这项可接受性和可行性研究具有重要意义