Longitudinal Mixed Method Study of Chronic Pain, PTSD, & CAM in OEF/OIF Veterans

描述(由申请人提供)：慢性疼痛是一种普遍的、使人虚弱的、代价高昂的国家健康问题。接受退伍军人医疗保健的OEF/OIF退伍军人中，近一半至少有一项与疼痛有关的有记录的诊断，但这一高危人群仍未得到充分研究。患有慢性疼痛和合并精神健康状况的退伍军人，特别是创伤后应激障碍，更有可能接受阿片类药物止痛，接受更大剂量的阿片类药物，并经历与阿片类药物相关的不良事件。因此，必须更好地了解部署后创伤后应激障碍和其他精神健康问题以及人格等广泛的易感因素如何有助于慢性疼痛结果的发展，并影响疼痛管理的卫生服务利用。还迫切需要更深入地了解OEF/OIF退伍军人对疼痛管理的观点，以开发干预措施，促进以患者为中心的护理模式，强调疼痛管理的整体方法，包括整合循证补充和替代医学(CAM)和其他非药理学疼痛管理方法。该项目的长期目标是改善疼痛管理，减少患有慢性疼痛和精神健康状况的退伍军人与阿片类药物相关的伤害。这项建议的主要目标是开发一个全面的模型，以了解慢性疼痛结局的发展，使用CAM和其他非药物方法，以及使用阿片类止痛剂治疗慢性疼痛，并更深入地了解退伍军人对疼痛管理方法的偏好和态度。具体目标是：1)确定OEF/OIF国民警卫队退伍军人中慢性疼痛的预测因素；2)表征CAM、其他非药理疼痛管理方法和阿片类止痛药的使用模式；3)测试医疗服务利用模式，以确定预期评估的易感个体特征；促进剂和障碍；以及预测OEF/OIF退伍军人使用CAM、其他非药理方法和阿片类止痛药的需求因素；以及4)通过更丰富地了解患者的慢性疼痛经历以及对疼痛管理健康服务的看法，确定影响OEF/OIF退伍军人使用CAM和其他非药理方法的潜在策略。拟议的项目将利用现有的纵向数据集，该数据集在部署OEF/OIF之前(2006-2010年)对3458名国民警卫队士兵进行了前瞻性评估，并对部署后各波的退伍军人进行了重新评估。目前的提案采用多阶段、混合方法设计，以创新的概念框架为指导，整合了人格理论、慢性疼痛的脆弱性-复原力模型和卫生服务使用的安徒生行为模型。它将通过增加另一波专注于慢性疼痛结果的量化数据和深入的定性数据来扩展现有的纵向队列，这些数据考察了老兵对慢性疼痛和疼痛管理健康服务的看法。

DESCRIPTION (provided by applicant): Chronic pain is a prevalent, debilitating, and costly national health problem. Nearly half of OEF/OIF Veterans receiving VA health care have at least one documented pain-related diagnosis, yet this high risk population remains understudied. Veterans with chronic pain and co-morbid mental health conditions, especially PTSD, are more likely to receive opioids for pain, to receive higher-dose opioids, and to experience opioid-related adverse events. Thus, it is imperative to better understand how post-deployment PTSD and other mental health problems as well as broad predisposing vulnerability factors such as personality might contribute to the development of chronic pain outcomes and influence health services utilization for pain management. There is also an urgent need to obtain a deeper understanding of OEF/OIF Veterans' perspectives on pain management to develop interventions that promote a patient-centered model of care emphasizing a holistic approach to pain management, including integration of evidence based complementary and alternative medicine (CAM) and other non-pharmacological pain management approaches. The long-term objective of this project is to improve pain management and reduce opioid-related harms for OEF/OIF Veterans with chronic pain and co-morbid mental health conditions. The primary goal of this proposal is to develop a comprehensive model for understanding the development of chronic pain outcomes, utilization of CAM and other non-pharmacological approaches, and utilization of opioid analgesics for chronic pain as well as gain a deeper understanding of Veterans' preferences and attitudes towards pain management approaches. Specific aims are to: 1) Identify predictors of chronic pain among OEF/OIF National Guard Veterans; 2) Characterize patterns of use of CAM, other non-pharmacological pain management approaches, and opioid analgesics; 3) Test a model of health services utilization that identifies prospectively assessed predisposing individual characteristics; facilitators and barriers; and need factors predictive of OEF/OIF Veterans' utilization of CAM, other non-pharmacological approaches, and opioid analgesics; and 4) Identify potential strategies for influencing OEF/OIF Veterans' use of CAM and other non-pharmacological approaches by gaining a richer understanding of patients' experiences with chronic pain and perspectives on pain management health services. The proposed project will capitalize on an existing longitudinal dataset that prospectively assessed 3,458 National Guard Soldiers prior to OEF/OIF deployments (2006-2010) and re-assessed Veterans across post-deployment waves. The current proposal utilizes a multi-phase, mixed methods design guided by an innovative conceptual framework integrating personality theory, a vulnerability-resilience model of chronic pain, and the Andersen Behavioral Model of Health Services Use. It will extend the existing longitudinal cohort by adding an additional wave of quantitative data focused on chronic pain outcomes and in-depth qualitative data examining Veteran perspectives on chronic pain and pain management health services.