Pain Management using Mobile Technology in Veterans with PTSD and TBI

描述（由申请人提供）：多达一半的创伤性脑损伤（TBI）退伍军人也患有共同发生的创伤后应激障碍（PTSD）。两者都与慢性疼痛的风险较高有关，这是在持久自由行动（阿富汗），伊拉克自由行动（伊拉克）和新黎明行动（OEF/OIF/OND）中服役的美国退伍军人最常见的健康问题之一。然而，止痛药会增加阿片类药物滥用的风险，研究表明，退伍军人认为传统的心理健康治疗存在障碍。关于旨在减轻患有创伤后应激障碍和创伤性脑损伤的退伍军人疼痛的非药物性、基于技术的干预措施的研究很少。用于实施神经反馈（EEG生物反馈）的移动的技术显示出提供便携式、低成本干预以减轻患有并发症的退伍军人疼痛的前景。在目前的R34中，我们的目标是测试使用移动的神经反馈设备减少创伤后应激障碍和创伤性脑损伤的退伍军人的疼痛症状的可行性和有效性。N=100名患有PTSD、TBI和慢性疼痛的OED/OIF/OND退伍军人将获得一个NeuroSky耳机（可以读取EEG脑电波）和一个带有名为“Cortex EEG”的应用程序的iPod Touch（可以提供神经反馈以诱导生理放松）。NeuroSky和Cortex EEG通过蓝牙连接，退伍军人被教导如何一起使用这些来进行神经反馈。在工作人员的帮助下，退伍军人还将在iPod日历中输入时间表和提醒，以便在家中或其他首选环境中自己练习神经反馈，每天20分钟，每周4次，持续12周。将在干预前后收集全面的数据。在此期间，我们将收集有关应用程序的数据 通过电话进行两次使用，并进行家访，以练习神经反馈，解决技术问题，并收集使用数据。在现有研究和初步数据的指导下，我们假设80%的参与者在3个月的研究持续时间内对NeuroSky + Cortex EEG干预表现出高水平的依从性（25次或更多次神经反馈），并且与基线相比，参与者在3个月时的疼痛症状在统计学上显著减少。鉴于疼痛和退伍军人的其他结果之间的联系，我们还将探讨药物滥用，暴力和自杀的影响。当研究完成后，这个领域将发生变化，因为我们将知道新技术阅读脑电图脑波是否可以用于治疗慢性疼痛患者的症状。我们还将知道神经反馈是否有希望作为创伤后应激障碍和创伤性脑损伤退伍军人的有效干预措施，以减少疼痛和相关结果。如果达到这些基准，R34将为未来的大规模随机临床试验奠定基础， 神经影像学和生理学测量，以查明干预减少疼痛的潜在机制，并确定改善是否长期持续。如果这项研究计划成功，其影响将是改变退伍军人和平民在临床实践中管理疼痛的方法。

DESCRIPTION (provided by applicant): Up to half of military veterans with traumatic brain injury (TBI) also suffer from co-occurring posttraumatic stress disorder (PTSD). Both are linked to higher risk of chronic pain, one of the most common health complaints among U.S. veterans who served in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and Operation New Dawn (OEF/OIF/OND). However, pain medications elevate risk of opioid abuse, and studies indicate that veterans perceive barriers to traditional mental health treatments. Littl research exists regarding non-pharmacological, technology-based interventions designed to reduce pain in veterans with PTSD and TBI. Mobile technology used to implement neurofeedback (EEG biofeedback) shows promise in providing a portable, low-cost intervention for reducing pain in veterans with co-occurring disorders. In the current R34, we aim to test the feasibility and effectiveness of using mobile neurofeedback devices for reducing pain symptoms in veterans with PTSD and TBI. N=100 OED/OIF/OND veterans with PTSD, TBI, and chronic pain will receive a NeuroSky headset (which reads EEG brain waves) and an iPod Touch with an app called "Cortex EEG" (which provides neurofeedback to induce physiological relaxation). NeuroSky and Cortex EEG are linked via Bluetooth, and veterans are taught how to use these together to do neurofeedback. With staff assistance, veterans will also enter a schedule and reminders into the iPod calendar to practice neurofeedback by themselves at home or other preferred setting 20 minutes a day, 4 times a week, for 12 weeks. Comprehensive data will be collected before and after the intervention. In the intervening period, we will collect data on app utilization twice by phone and conduct a home visit to practice neurofeedback, troubleshoot technical problems, and collect data on utilization. Guided by existing research and preliminary data, we hypothesize that 80% of participants will show high levels of adherence (25 or more sessions of neurofeedback) to the NeuroSky + Cortex EEG intervention for the 3-month study duration and that participants will show statistically significant reduction in pain symptoms at 3 months compared to baseline. Given links between pain and other outcomes in veterans, we will also explore effects on drug abuse, violence, and suicidality. When the research is complete, the field will be changed because we will know whether new technology reading EEG brainwaves can be used to treat symptoms among individuals suffering from chronic pain. We will also know whether neurofeedback shows promise as an effective intervention for veterans with PTSD and TBI to reduce pain and related outcomes. If these benchmarks are achieved, the R34 will lay the groundwork for a future, large scale randomized clinical trial employing objective neuroimaging and physiological measures to pinpoint mechanisms underlying reduced pain from the intervention and to determine whether improvement persists long term. If this program of research is successful, its impact will be to shift approaches to managing pain in clinical practice, for both veterans and civilians.