Intensive Treatment of Chronic Pain and PTSD for OEF/OIF Veterans

描述(由申请人提供)： 摘要OEF/OIF退伍军人慢性疼痛和创伤后应激障碍的强化治疗目的：本研究的主要目的是评价持续自由和伊拉克自由行动(OEF/OIF)退伍军人合并慢性疼痛和创伤后应激障碍(PTSD)的强化综合治疗的疗效。第二个目标是检查可能导致疼痛或创伤后应激障碍改善的潜在作用机制。第三，将进行探索性分析，以评估参与治疗和认知功能之间的关系。假设1)与随机进入标准护理(SC)状态的参与者相比，接受强化治疗(PT)的参与者报告的疼痛症状和PTSD从治疗前到治疗后的下降幅度将显著更大；以及2)与随机进入SC状态的参与者相比，接受强化治疗(PT)的参与者在完成治疗后的3个月将表现出更大程度的疼痛和创伤后应激障碍的变化。研究设计：本研究为两种治疗条件(强化综合疼痛和创伤后应激障碍治疗(PT)与标准护理(SC))，由三个评估期(治疗前、治疗后和3个月随访)重复设计，具有多种从属措施。方法：参与者将是102名OEF/OIF退伍军人，他们在波士顿退伍军人管理局和康涅狄格州退伍军人医疗系统接受治疗，同时被诊断为慢性疼痛和创伤后应激障碍。如果患者有持续疼痛至少三个月的神经或肌肉骨骼病因学，他们将有资格参加。患者还必须符合创伤后应激障碍的DSM-IV诊断标准。有生命危险或急性身体疾病、目前酗酒或滥用药物、目前有精神病或自杀意念的患者，以及寻求手术干预等疼痛治疗的个人将被排除在外。访谈、自我报告方法和神经心理测试将被用来进行参与者评估。随机进入PT状态的参与者将参加6次每周6次的门诊治疗，以个人形式进行，每次90分钟。随机进入SC状态的参与者将继续通过退伍军人管理局接受标准医疗护理。分析将检查每种条件的影响以及群体效应之间的影响。 公共卫生相关性： 项目叙述持久行动和伊拉克自由(OEF/OIF)导致越来越多的受伤士兵被疏散到美国，接受与身体和心理创伤有关的全面护理，最常见的是疼痛和创伤后应激障碍(PTSD)。这些疾病往往是同时发生的，并导致高度的痛苦症状。因此，当务之急是在这些疾病变得慢性和抗拒变化之前，为它们开发有效、省时的治疗方法。这项研究调查了OEF/OIF退伍军人的慢性疼痛和创伤后应激障碍的治疗，通过一个简短的综合治疗模式。这项研究的目标与VHA国家疼痛管理战略一致，该战略确保退伍军人管理局医疗系统中所有接受护理的人都可以可靠地依靠及时和适当的疼痛治疗。这项研究最终旨在帮助因疼痛和创伤后应激障碍而遭受社会、职业和个人痛苦的OEF/OIF退伍军人，并旨在帮助退伍军人迅速恢复更适应、更健康的日常生活。

DESCRIPTION (provided by applicant): ABSTRACT Intensive Treatment of Chronic Pain and PTSD for OEF/OIF Veterans Objectives: The primary objective of this study is to evaluate the efficacy of an intensive integrated treatment for Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans with comorbid chronic pain and posttraumatic stress disorder (PTSD). A secondary objective is to examine potential mechanisms of action that might account for improvements in pain or PTSD. Third, exploratory analyses will be conducted to assess the relationship between participation in treatment and cognitive functioning. It is hypothesized that 1) participants receiving the intensive treatment (PT) will report significantly greater decreases in symptoms of pain and PTSD from pre-treatment to post-treatment when compared to participants randomized to a standard care (SC) condition, and 2) participants receiving PT will show greater maintenance of change on measures of pain and PTSD at 3 months following the completion of treatment when compared to participants randomized to the SC condition. Research Design: The proposed study is a two treatment condition (Intensive Integrated Pain and PTSD Treatment (PT) vs. Standard Care (SC)) by three evaluation period (pre-treatment, post-treatment, and 3-month follow-up) repeated measures design with multiple dependent measures. Methodology: Participants will be 102 OEF/OIF veterans receiving care in the VA Boston and VA Connecticut Healthcare Systems with a co-morbid diagnosis of chronic pain and PTSD. Patients will be eligible to participate if they have constant pain of at least three months duration with a neurologic or musculoskeletal etiology. Patients must also meet DSM-IV diagnostic criteria for PTSD. Patients with life threatening or acute physical illness, current alcohol or substance abuse, current psychosis or suicidal ideation, and individuals seeking pain treatment such as surgical interventions will be excluded. Interview, self-report methodology, and neuropsychological testing will be utilized to conduct participant assessments. Participants randomized to the PT condition will attend 6 bi-weekly outpatient therapy sessions conducted in an individual format of 90 minutes in duration. Participants randomized to the SC condition will continue to receive standard medical care through the VA. Analyses will examine the effects of each condition as well as between group effects. PUBLIC HEALTH RELEVANCE: Project Narrative Operations Enduring and Iraqi Freedom (OEF/OIF) have resulted in a growing number of injured soldiers who have been evacuated to the United States for comprehensive care related to both physical and psychological trauma, most commonly pain and Post-Traumatic Stress Disorder (PTSD). These disorders tend to co-occur and result in high levels of distressing symptoms. Thus, it is imperative to develop effective, time-efficient treatments for these disorders before they become chronic and resistant to change. This study investigates the treatment of chronic pain and PTSD in OEF/OIF veterans through a brief, integrated treatment format. The study goals are consistent with the VHA National Pain Management Strategy, which assures that all persons cared for in the VA healthcare system can reliably count on prompt and appropriate treatment of pain. This study ultimately aims to help OEF/OIF veterans who are suffering socially, vocationally, and personally due to their pain and PTSD and aims to help veterans return quickly to a more adaptive, healthy daily life.