Pain Management using Mobile Technology in Veterans with PTSD and TBI

描述（由申请人提供）：高达一半的创伤性脑损伤（TBI）退伍军人同时患有创伤后应激障碍（PTSD）。两者都与慢性疼痛的高风险有关，慢性疼痛是在持久自由行动（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，止痛药增加了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。关于非药物、基于技术的干预措施旨在减轻创伤后应激障碍和创伤性脑损伤退伍军人的疼痛的研究很少。用于实现神经反馈（脑电图生物反馈）的移动技术有望提供一种便携式、低成本的干预措施，以减轻患有并发疾病的退伍军人的疼痛。在当前的R34中，我们的目的是测试使用移动神经反馈设备减轻创伤后应激障碍和创伤性脑损伤退伍军人疼痛症状的可行性和有效性。100名患有创伤后应激障碍、创伤性脑损伤和慢性疼痛的OED/OIF/OND退伍军人将接受NeuroSky耳机（读取脑电图脑电波）和带有“皮质脑电图”应用程序的iPod Touch（提供神经反馈以诱导生理放松）。NeuroSky和Cortex EEG通过蓝牙连接在一起，退伍军人被教导如何一起使用它们来做神经反馈。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，以便自己在家或其他首选设置练习神经反馈，每天20分钟，每周4次，持续12周。在干预前后将收集全面的数据。在此期间，我们将收集app上的数据

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.