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）：多达一半的脑损伤的退伍军人（TBI）也患有创伤后应激障碍（PTSD）。两者都与慢性疼痛的较高风险有关，这是在持久自由运营（阿富汗），伊拉克自由行动（伊拉克）和新黎明行动（OEF/OIF/OIF/OND）中服役的美国退伍军人中最常见的健康投诉之一。但是，止痛药提高了阿片类药物滥用的风险，研究表明，退伍军人认为传统的心理健康治疗障碍。关于非药理，基于技术的干预措施的LITTL研究旨在减轻PTSD和TBI退伍军人的疼痛。用于实施神经反馈的移动技术（EEG Biofefback）在提供便携式，低成本的干预措施方面有望减轻同时发生疾病的退伍军人的疼痛。在当前R34中，我们旨在测试使用移动神经反馈设备减少PTSD和TBI退伍军人的疼痛症状的可行性和有效性。 n =具有PTSD，TBI和慢性疼痛的100 OED/OIF/OND退伍军人将接收神经耳机耳机（读取EEG脑波）和带有名为“ Cortex EEG”的应用程序的iPod Touch（可提供神经反馈可诱导生理放松）。 Neurosky和Cortex EEG通过蓝牙链接，并教退伍军人如何将它们一起使用神经反馈。在员工协助的情况下，退伍军人还将进入时间表，并提醒iPod日历，以在家中自己或其他首选设置每天20分钟，每周4次，持续12周。在干预之前和之后，将收集全面的数据。在此期间，我们将收集应用程序的数据 通过电话两次利用并进行家庭访问，以练习神经反馈，对技术问题进行故障排除并收集有关利用率的数据。在现有的研究和初步数据的指导下，我们假设80％的参与者将表现出高水平的依从性（25个或更多的神经反馈会话）与神经 +皮质 +皮质EEG EEG EEG干预有关3个月的研究持续时间，并且参与者将在3个月中显示出统计学上的疼痛症状显着降低。鉴于疼痛与退伍军人的其他结果之间的联系，我们还将探讨对滥用药物，暴力和自杀性的影响。研究完成后，该领域将会改变，因为我们会知道是否可以使用新技术阅读EEG脑电波来治疗患有慢性疼痛的人的症状。我们还将知道神经反馈是否表现出对患有PTSD和TBI退伍军人的有效干预，以减轻疼痛和相关结果。如果实现了这些基准，R34将为未来的大规模随机临床试验奠定基础 神经影像学和生理措施以查明干预措施减轻疼痛的机制，并确定改善是否持续长期。如果该研究计划是成功的，那么它的影响将是向退伍军人和平民管理临床实践中的疼痛的方法。