Adaptation of Mindfulness Training to Treat Chronic Pain in the Military

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公共卫生优先事项。此应用程序将测试的可接受性和可行性， 互动的，基于网络的正念训练与现役士兵正在治疗慢性疼痛。我们将调整以证据为基础的正念减压（MBSR）计划，用于这一人群。将利用现有的应用程序平台，通过移动的应用程序（应用程序）进行技能练习，从而加强培训。研究参与者将从位于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，该中心是全国八个IPMC之一，其工作通过其跨学科，整体和多模式的疼痛管理方法为国防部制定标准。军队中慢性疼痛的发病率非常高，从28%到82%不等。伊拉克和阿富汗退伍军人的伤残和医疗费用估计在3500亿至7000亿美元之间。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同时发生。正念减压疗法有一个良好的证据基础，可以有效地减少抑郁、焦虑、压力、失眠和药物滥用。正念减压疗法也能有效缓解疼痛症状。然而，军队的独特环境与平民环境截然不同。这些变化影响了标准MBSR训练的可行性和可接受性，强调需要进行初步研究，包括熟练的适应过程，预测试和试点测试，从而为更大的疗效试验奠定基础。本研究的具体目的如下：目的1。为军队调整基于证据的MBSR计划，并在现有平台上添加应用程序以开发初步协议。目标二。在早期预测试阶段评估基于网络的初步方案和应用程序的可用性（1组; N=8），以便手动创建测试方案;目标3。测试测试方案和应用程序的可行性和可接受性（4-5个连续组; N=32-40）。正念方案将通过现有的基于网络的平台提供，以提高程序的可访问性和覆盖范围。这些应用程序将利用一个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，循证方案的适应，移动的健康技术和军事健康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

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