Bright Light Treatment At Home To Manage Chronic Pain In U.S. Veterans

描述（由申请人提供）：近50%的美国退伍军人报告说，他们经常感到疼痛。这种慢性疼痛通常与其他疾病共同发生，包括创伤后应激障碍，抑郁症，焦虑和失眠。治疗慢性疼痛的一种常见方法是阿片类镇痛剂，但并不总是有效，而且越来越多地与滥用和误用有关。因此，迫切需要开发容易获得，安全和实用的补充非药物方法来管理美国退伍军人的慢性疼痛。慢性疼痛是一个多方面的现象，与许多因素相关，包括消极情绪和睡眠不良。位于下丘脑视交叉上核的中央生物钟被公认可以调节情绪和睡眠，即使是生物钟/睡眠时间的微小延迟（之后的变化）也与抑郁和睡眠中断有关。这些结果表明，较晚的昼夜节律/睡眠时间可能是疼痛的一个可改变的风险因素。我们的试点数据 建议：（1）较晚的昼夜节律/睡眠定时与更差的愤怒、抑郁、焦虑、疲劳和身体功能相关;（2）自我管理的基于家庭的亮光治疗在改变昼夜节律相位方面是有效的。因此，在家里自我管理的强光治疗可能是一个潜在的有效的治疗策略，用于管理慢性疼痛。这项R34提案将开发一种早晨明亮的光线治疗，以帮助管理慢性疼痛，改善美国退伍军人的PTSD症状，抑郁，焦虑和睡眠。患者将在家中有7个基线日，然后进行基线疼痛敏感性评估和家庭昼夜节律时相评估（昏暗灯光褪黑激素发作）。在指导性家庭访视后，患者将自行进行6天的早晨明亮光治疗，然后重新评估疼痛敏感性和昼夜节律相位。在另外7天的早晨明亮光处理后重复评估。在整个基线和治疗期间，每天评估疼痛、情绪和睡眠（腕动记录）。在停止光治疗后的1个月随访期间，还将由退伍军人每天对疼痛、情绪和睡眠进行评估。目标1是确定强光治疗对患有慢性腰痛的美国退伍军人（n=30）样本的可行性和可接受性。目的2是检查6天和13天的强光治疗对慢性疼痛强度和敏感性的影响（改善PTSD症状，情绪和睡眠是次要结果），以揭示影响充分减轻疼痛反应所需的治疗持续时间。目的3是确定光治疗停止后治疗反应衰减的时间过程，以获得用于维持亮光治疗（例如每两天或每三天一次亮光）的发展的信息。该项目的长期意义在于需要开发易于获得，安全和实用的方法来管理美国退伍军人的慢性疼痛，而不仅仅是基于镇痛药物。更直接的是，该项目将检查围绕实施有效的强光治疗过程的重要参数，为未来的临床试验提供重要基础。

DESCRIPTION (provided by applicant): Nearly 50% of U.S. veterans report they experience pain on a regular basis. This chronic pain often co-occurs with other disorders including PTSD, depression, anxiety and insomnia. A common approach to treating chronic pain is opioid analgesics, which are not always effective, and increasingly associated with abuse and misuse. Thus, there is an urgent need to develop readily available, safe, and practical complementary non-pharmacological approaches to manage chronic pain in U.S. veterans. Chronic pain is a multidimensional phenomenon, inter-related with many factors, including negative mood and poor sleep. The central circadian clock, in the suprachiasmatic nucleus in the hypothalamus, is well recognized to regulate both mood and sleep, and even small delays (shifts later) in circadian/sleep timing are associated with depression and disrupted sleep. These results suggests that later circadian/sleep timing may be a modifiable risk factor for pain. Our pilot data suggest that: (1) later circadian/sleep timing is associated with worse anger, depression, anxiety, fatigue and physical function; (2) a self-administered home based bright light treatment is effective at shifting circadian phase. Thus, self-administered bright light treatment at home may be a potentially efficacious adjunctive strategy for managing chronic pain. This R34 proposal will develop a morning bright light treatment to help manage chronic pain and improve PTSD symptoms, depression, anxiety and sleep in U.S. veterans. Patients will have 7 baseline days at home, followed by a baseline pain sensitivity assessment and home circadian phase assessment (dim light melatonin onset). Following an instructional home visit, patients will then self- administer morning bright light treatment for 6 days, followed by reassessments of pain sensitivity and circadian phase. Assessments will be repeated after another 7 days of morning bright light treatment. Pain, mood and sleep (wrist actigraphy) will be assessed daily throughout baseline and treatment. Pain, mood and sleep will also be rated by veterans daily during a 1 month follow up after cessation of light treatment. Aim 1 is to determine the feasibility and acceptability of bright light treatment in a sample of U.S. veterans (n=30) experiencing chronic low back pain. Aim 2 is to examine the effects of 6 days and 13 days of bright light treatment on their chronic pain intensity and sensitivity (improved PTSD symptoms, mood and sleep are secondary outcomes) to reveal the treatment duration needed to affect an adequate pain reduction response. Aim 3 is to determine the time course of decay of treatment response after cessation of light treatment to gain information for the development of a maintenance bright light treatment (e.g. bright light every second or third day). Long-term significance of this project addresses the need to develop readily available, safe, and practical approaches to manage chronic pain in U.S. veterans not exclusively based on analgesic medications. More immediately, the project will examine important parameters surrounding the implementation of an effective course of bright light treatment to provide an important foundation for a future clinical trial.