Pain Management using Mobile Technology in Veterans with PTSD and TBI

使用移动技术对患有 PTSD 和 TBI 的退伍军人进行疼痛管理

• 批准号: 8753690
• 负责人: ERIC B. ELBOGEN
• 金额: $ 30.4万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8753690
• 关键词: Adherence; Afghanistan; Ambulatory Care Facilities; Analgesics; Behavioral; Benchmarking; Biofeedback; Brain; Calendar; Caring; Clinic; Clinical; Data; Development; Devices; Distress; Drug abuse; Drug usage; Economics; Educational process of instructing; Effectiveness; Electroencephalography; Emotional; Enrollment; Ensure; Freedom; Funding; Future; Goals; Grant; Health; Home environment; Home visitation; House Call; Individual; Institution; Intervention; Iraq; Link; Measures; Mental Health; Military Personnel; National Institute of Mental Health; North Carolina; Operations Research; Outcome; Pain; Pain management; Participant; Personal Satisfaction; Pharmacological Treatment; Physiological; Post-Traumatic Stress Disorders; Publishing; Randomized Clinical Trials; Reading; Registries; Relaxation; Reporting; Research; Research Personnel; Risk; Schedule; Suicide; Symptoms; Technology; Telephone; Testing; Time; Touch sensation; Translating; Traumatic Brain Injury; Travel; Triad Acrylic Resin; Universities; Use Effectiveness; Veterans; Violence; Work; alternative treatment; base; chronic pain; clinical practice; cognitive function; cost; dual diagnosis; effective intervention; high risk; improved; innovation; meetings; neurofeedback; neuroimaging; new technology; operation; opioid abuse; post intervention; programs; public health relevance; social; social stigma; success; therapy design; tool; traditional care; usability

DESCRIPTION (provided by applicant): Up to half of military veterans with traumatic brain injury (TBI) also suffer from co-occurring posttraumatic stress disorder (PTSD). Both are linked to higher risk of chronic pain, one of the most common health complaints among U.S. veterans who served in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and Operation New Dawn (OEF/OIF/OND). However, pain medications elevate risk of opioid abuse, and studies indicate that veterans perceive barriers to traditional mental health treatments. Littl research exists regarding non-pharmacological, technology-based interventions designed to reduce pain in veterans with PTSD and TBI. Mobile technology used to implement neurofeedback (EEG biofeedback) shows promise in providing a portable, low-cost intervention for reducing pain in veterans with co-occurring disorders. In the current R34, we aim to test the feasibility and effectiveness of using mobile neurofeedback devices for reducing pain symptoms in veterans with PTSD and TBI. N=100 OED/OIF/OND veterans with PTSD, TBI, and chronic pain will receive a NeuroSky headset (which reads EEG brain waves) and an iPod Touch with an app called "Cortex EEG" (which provides neurofeedback to induce physiological relaxation). NeuroSky and Cortex EEG are linked via Bluetooth, and veterans are taught how to use these together to do neurofeedback. With staff assistance, veterans will also enter a schedule and reminders into the iPod calendar to practice neurofeedback by themselves at home or other preferred setting 20 minutes a day, 4 times a week, for 12 weeks. Comprehensive data will be collected before and after the intervention. In the intervening period, we will collect data on app utilization twice by phone and conduct a home visit to practice neurofeedback, troubleshoot technical problems, and collect data on utilization. Guided by existing research and preliminary data, we hypothesize that 80% of participants will show high levels of adherence (25 or more sessions of neurofeedback) to the NeuroSky + Cortex EEG intervention for the 3-month study duration and that participants will show statistically significant reduction in pain symptoms at 3 months compared to baseline. Given links between pain and other outcomes in veterans, we will also explore effects on drug abuse, violence, and suicidality. When the research is complete, the field will be changed because we will know whether new technology reading EEG brainwaves can be used to treat symptoms among individuals suffering from chronic pain. We will also know whether neurofeedback shows promise as an effective intervention for veterans with PTSD and TBI to reduce pain and related outcomes. If these benchmarks are achieved, the R34 will lay the groundwork for a future, large scale randomized clinical trial employing objective neuroimaging and physiological measures to pinpoint mechanisms underlying reduced pain from the intervention and to determine whether improvement persists long term. If this program of research is successful, its impact will be to shift approaches to managing pain in clinical practice, for both veterans and civilians.

描述（由申请人提供）：多达一半患有创伤性脑损伤 (TBI) 的退伍军人还同时患有创伤后应激障碍 (PTSD)。两者都与较高的慢性疼痛风险有关，这是参与持久自由行动（阿富汗）、伊拉克自由行动（伊拉克）和新黎明行动（OEF/OIF/OND）的美国退伍军人中最常见的健康问题之一。然而，止痛药会增加阿片类药物滥用的风险，研究表明退伍军人认为传统心理健康治疗存在障碍。关于非药物、基于技术的干预措施的研究很少，旨在减轻患有 PTSD 和 TBI 的退伍军人的疼痛。用于实施神经反馈（脑电图生物反馈）的移动技术有望提供便携式、低成本的干预措施，以减轻患有并发疾病的退伍军人的疼痛。在当前的 R34 中，我们的目标是测试使用移动神经反馈设备减轻患有 PTSD 和 TBI 退伍军人疼痛症状的可行性和有效性。 N=100 名患有 PTSD、TBI 和慢性疼痛的 OED/OIF/OND 退伍军人将收到 NeuroSky 耳机（可读取 EEG 脑电波）和带有名为“Cortex EEG”的应用程序（提供神经反馈以诱导生理放松）的 iPod Touch 。 NeuroSky 和 ​​Cortex EEG 通过蓝牙连接，退伍军人被教导如何将它们一起使用来进行神经反馈。在工作人员的帮助下，退伍军人还将在 iPod 日历中输入时间表和提醒，以便在家或其他首选环境中自行练习神经反馈，每天 20 分钟，每周 4 次，持续 12 周。将在干预前后收集综合数据。在此期间，我们将收集应用程序上的数据 通过电话两次使用并进行家访，以练习神经反馈、解决技术问题并收集使用数据。根据现有研究和初步数据，我们假设 80% 的参与者将在 3 个月的研究期间表现出对 NeuroSky + Cortex EEG 干预的高水平依从性（25 次或更多神经反馈疗程），并且参与者将表现出统计显着性与基线相比，3 个月时疼痛症状减轻。鉴于退伍军人的疼痛与其他结果之间的联系，我们还将探讨对药物滥用、暴力和自杀的影响。当研究完成后，这个领域将会发生改变，因为我们将知道读取脑电图脑电波的新技术是否可以用于治疗慢性疼痛患者的症状。我们还将了解神经反馈是否有望成为患有 PTSD 和 TBI 的退伍军人的有效干预措施，以减轻疼痛和相关结果。如果实现这些基准，R34 将为未来采用目标的大规模随机临床试验奠定基础 神经影像和生理测量，以查明干预措施减轻疼痛的机制，并确定改善是否能长期持续。如果该研究计划成功，其影响将是改变退伍军人和平民在临床实践中控制疼痛的方法。