Mental Function And Quality Of Life With Chronic Pain

背景：慢性疼痛在退伍军人中很常见，明智的康复计划是避免有害的关键 功能结果和其他生活质量(QOL)的结果。疼痛后获得最佳功能结果 然而，康复是具有挑战性的，因为很大一部分残疾是由“非器质性”造成的。 心理因素。主要由心理因素造成的残疾会使退伍军人一贫如洗 侵入性医疗程序的候选者(这将具有最小的好处和潜在的危害)。无机物 传统上，疼痛是通过临床医生评定的“Waddell征”来探测的。然而，这些迹象并不一致 以可疑的评分者之间的可靠性进行调查，并且在VHA中可能具有挑战性，其中症状认可 可以在财务上得到加强。因此，迫切需要一个对时间敏感、难以伪装的客观标志。 将心理驱动的残疾纳入治疗计划。该项目是一项概念验证研究，旨在确定 潜意识中对疼痛的偏见，如被疼痛相关刺激捕获的注意力，是否与情绪相关 进食时心理驱动的残疾的症状学和临床医生印象，具有探索性目的 将偏倚指标与疼痛治疗结果联系起来。方法：在15个月的时间里，50名退伍军人被提名参加 在退伍军人医疗中心(VAMC)疼痛诊所进行的评估，以及30名退伍军人被安排在非疼痛相关的 将从电子病历(EMR)中识别具有最小疼痛病史的预约(例如初级护理) 并在入职预约之前联系，并被邀请完成约90分钟的评估小组 便携式触摸屏-平板电脑-PC，无论是在他们的家里还是在VAMC。这个电池将由以下组件组成 基于面谈的疼痛症状和残疾(例如，职业功能)、情感工具 症状和生活质量，以及潜意识偏向疼痛的神经认知任务的表现- 与疼痛相关的概念/词语和图像。冲动和耐受挫的比较者任务将 也包括在内。这项评估将以患者对负担或厌恶程度进行评级而结束 评估本身。在这次评估后的六个月，参与者将通过电话重复 访谈基线时探查的疼痛症状、疼痛残疾和生活质量评估项目。除了核心之外 探讨退伍军人慢性疼痛计算机化偏见评估的可行性，分析将检验 原因：1)疼痛患者和非疼痛患者在潜意识疼痛偏向上的差异，以及2)疼痛和非疼痛患者之间的相关性 潜意识偏差和基线时的情绪/疼痛/残疾/生活质量症状评分，以评估 探讨疼痛患者的潜意识偏向测量。作为增值的补充分析，我们将：1)联系 对入院临床医生的Waddell评分的评估项目(偏见任务和面谈工具得分) 在EMR中，2)注意(内隐)偏向分数与随访时的疼痛和残疾等级有关。后续功绩 项目：许多退伍军人表现出心理驱动的残疾迹象，他们不愿收养提供者 寻求综合性精神卫生保健的建议。为了帮助提供者激励这些患者，后续 功绩研究将收集患有心理驱动的疼痛残疾的退伍军人有选择地受益的证据 从包罗万象的心理健康护理中脱身。最强的神经行为标记物(自我报告和临床医生- 被评为心理困扰)来自笔记本电脑的评估i21项目将被移植到移动应用程序测试 用于全面观察性研究的平台，旨在显示APP(任务)结果是否可预测疼痛 治疗结果取决于是否使用了精神卫生服务。这些数据将使 测试应用程序以向患者和提供者返回实际的偏向“风险”分数。在随后的该应用程序的临床试验中 风险评分，我们将比较心理风险评级为(一项研究)时的功能康复结果 ARM)VS不能(其他ARM)提供给提供者用于治疗计划。康复方面的结果 将跟踪整个QOL和疼痛症状，并将其作为(交互作用的函数)在组之间进行比较 与APP标记的(可能的非器质性疼痛)病例是否得到综合心理健康服务。

Background: Chronic pain is common in Veterans and astute rehabilitation plans are critical to avoid deleterious outcomes for functional outcomes and other quality of life (QoL). Attaining optimal functional outcomes after pain rehabilitation is challenging, however, in cases when a significant portion of disability stems from “nonorganic” psychological factors. Disability from primarily psychologically-driven factors would make a Veteran a poor candidate for invasive medical procedures (which would have minimal benefit and potential harms). Nonorganic pain has been traditionally probed using clinician-rated “Waddell signs.” However, these signs are inconsistently probed, with questionable inter-rater reliability and can be challenging in the VHA wherein symptom endorsement can be financially reinforced. Therefore, there is a critical need for a time-sensitive, hard-to-feign objective marker of psychologically-driven disability for treatment planning. This project is a proof-of-concept study to determine whether subconscious bias toward pain, such as attentional capture by pain-related stimuli, correlates with mood symptomatology and clinician impressions of psychologically-driven disability at intake, with an exploratory aim of relating bias metrics to pain treatment outcomes. Approach: Over a 15-month period, 50 Veterans slated for assessment at a VA medical center (VAMC) pain clinic and 30 “control” Veterans slated for a non-pain-related appointment (e.g. Primary Care) with minimal pain histories will identified from electronic medical records (EMR) and approached prior to their intake appointment and invited to complete a ~90-minute assessment battery on a portable touchscreen-tablet-PC, either in their home or at the VAMC. This battery will be composed of interview-based instruments of pain symptomatology and disability (e.g. occupational function), affective symptomatology and QoL, as well as performance of neurocognitive tasks of subconscious bias toward pain- related concepts/words and pain-related images. Comparator tasks of impulsivity and frustration tolerance will also be included. This assessment will conclude with the patient making ratings of the burden or aversiveness of the assessments themselves. Six months following this assessment, participants will repeat by telephone interview the pain symptom, pain disability and QoL assessment items probed at baseline. In addition to the core goal of probing the feasibility of computerized bias assessment in Veterans with chronic pain, analyses will test for: 1) differences in subconscious pain bias between pain and non-pain patients, and 2) correlations between subconscious bias and mood/pain/disability/QoL symptom scores at baseline, to assess the core validity of probing subconscious bias measures in pain patients. As value-added supplemental analyses, we will: 1) relate assessment items (both bias tasks and interview instrument scores) to Waddell ratings of intake clinicians noted in EMR, 2) relate attentional (implicit) bias scores to pain and disability ratings at follow-up. Follow-on MERIT projects: Many Veterans who show signs of psychologically-driven disability are reluctant to adopt provider recommendations to seek integrative mental health care. To help providers motivate these patients, follow-on MERIT studies will collect evidence that Veterans with psychologically-driven pain disability selectively benefit from wrap-around mental health care. The strongest neurobehavioral markers (of self-reported and clinician- rated psychological distress) from the laptop assessment of this I21 project will be ported to a mobile app testing platform for a full-scale observational study designed to show whether app (task) results are predictive of pain treatment outcomes, as a function of whether mental health services were utilized. These data will enable the testing app to return actual bias “risk” scores to the patient and provider. In a subsequent clinical trial of the app’s risk score, we will compare functional rehabilitation outcomes when the psychological risk rating is (one study arm) vs is not (other arm) available to the provider for treatment planning. Rehabilitation outcomes in terms of whole QoL and pain symptomatology will be tracked and compared between groups as a function of (interaction with) whether app-flagged (probable-nonorganic pain) cases were given integrative mental health services.