Longitudinal Study of Post-Deployment CAM Pain Management Using DoD and VA Data

使用 DoD 和 VA 数据进行部署后 CAM 疼痛管理的纵向研究

• 批准号: 8912367
• 负责人: Mary Jo Larson
• 金额: $ 57.56万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8912367
• 关键词: Acupuncture Therapy; Afghanistan; Alcohol or Other Drugs use; Back; Biofeedback; Caring; Categories; Chronic; Clinic; Clinical; Clinical Services; Cohort Studies; Collection; Comorbidity; Complement; Complementary and alternative medicine; Data; Data Analyses; Data Collection; Data Set; Databases; Department of Defense; Diagnosis; Distress; Dose; Environment; Gender; Health; Health Services; Health Services Administration; Health Status; Health system; Healthcare; Healthcare Systems; Human Resources; Individual; Information Systems; Injury; Iraq; Joints; Location; Longitudinal Studies; Measures; Medical; Medicine; Mental Depression; Military Personnel; Morbidity - disease rate; Musculoskeletal; Musculoskeletal Diseases; Opioid; Outcome; Pain; Pain Clinics; Pain management; Patients; Pattern; Patterns of Care; Persons; Pharmaceutical Preparations; Poisoning; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Prevalence; Procedures; Provider; Recovery; Reporting; Risk; Services; Severities; Source; Subgroup; Substance Use Disorder; Symptoms; System; Technology; Time; Traumatic Brain Injury; Veterans; War; arm; behavioral health; chronic pain; cohort; combat; dosage; follow-up; health administration; health care delivery; improved; indexing; injured; innovation; longitudinal analysis; medical specialties; member; prescription opioid; prescription opioid misuse; psychologic; trend

DESCRIPTION (provided by applicant): Military duties place personnel at unique risk for chronic pain. The Armed Forces is concerned about increasing reports of prescription opioid misuse and overreliance on medications, and is seeking to expand its chronic pain management (PM) approaches. Thus, it is essential to thoroughly investigate the non-pharmacological approaches to chronic PM that the Department of Defense (DoD) and Veterans Health Administration (VHA) are making available, including complementary and alternative medicine (CAM) treatments. This application is to expand data collection and reanalyze a unique longitudinal data set of cohorts returning from deployment to Afghanistan and Iraq in order to: a) determine how CAM/non-pharmacological PM approaches are used to treat chronic pain, b) explore if CAM/non-pharmacological PM are substitutes (or complementary) to opioid use; and, examine long-term outcomes in cohort members treated for chronic pain. Specifically: Aim 1: Describe the prevalence of postdeployment chronic pain by source and severity for active duty and reserve component Army members. Describe the prevalence and utilization (organization, duration, and intensity) of key PM clinical services used postdeployment for Army members with chronic pain. Aim 2: Investigate for which subgroups (e.g., gender, TBI), and in which health care environments, CAM services are used to treat chronic pain as a complement with prescription opioids, or as a substitute for prescription opioids. Aim 3: Investigate whether utilization of CAM as part of chronic PM is associated with postdeployment outcomes spanning 3 to 5 years postdeployment. This application will expand the Substance Use and Psychological Injury Combat Study (SUPIC) by including members from additional cohort years, extending the follow-up period, and deriving new measures specific to pain diagnoses and pain treatments. The application is innovative in its: a) focus on services for cohorts returning from deployment in FY2008-2014, b) collection of longitudinal data up to 5 years follow-up, and c) merging and analysis of person-level health system data from the two health care systems responsible for postdeployment medical services: DoD's Military Health System (MHS) and the VHA. We estimate that 120,000 cohort members will be identified with chronic pain within the first few months of return from a deployment to Afghanistan/Iraq. Because longitudinal data inclusive of MHS and VHA services are analyzed, this application is uniquely positioned to track over time, at the system-level, the extensiveness of CAM/non- pharmacological PM and the prevalence of opioid use for returning members, and, at the person-level, the joint use of PM services with use of opioids, and the association of different PM approaches with a 'recovery' trajectory (gradual improvement), or less favorable outcomes such as substance use disorder, increasing comorbidity, or a 'chronic trajectory.' These findings will assist DoD and VHA decision-makers to improve current patterns of care and to reduced distress and morbidity among injured and ill service members.

描述（由申请人提供）：军事职责使人员处于慢性疼痛的独特风险。武装部队担心增加处方阿片类药物滥用和过度依赖药物的报告，并正在寻求扩大其慢性疼痛管理（PM）方法。因此，必须彻底研究国防部（DOD）和退伍军人卫生管理局（VHA）的慢性PM的非药物方法，包括补充和替代医学（CAM）治疗。该应用程序是为了扩展数据收集并重新分析了从部署到阿富汗和伊拉克返回的独特纵向数据集，以：a）确定CAM/非药物PM方法如何使用慢性疼痛来治疗慢性疼痛，b）探索cam/non-dem-PMARACACIC PM是替代（或配置）是否是替代品（或配置）到OPIOICIEID的使用；并且，检查接受慢性疼痛治疗的队列成员的长期结局。具体来说：目标1：描述源自现役和预备役部队成员的来源和严重程度的慢性疼痛的患病率。描述关键PM临床服务的普遍性和利用率（组织，持续时间和强度）使用慢性疼痛的陆军成员使用后的部门。 AIM 2：研究哪些亚组（例如性别，TBI），以及在哪些医疗保健环境中，CAM服务用于将慢性疼痛作为与处方阿片类药物的补充，或代替处方阿片类药物的替代品。 AIM 3：研究CAM作为慢性PM的一部分是否与跨部门后3至5年的部门后结果有关。 该应用将通过包括额外队列年份的成员，延长随访期，并得出针对疼痛诊断和疼痛治疗的新措施，从而扩大药物使用和心理伤害作战研究（Supic）。该应用程序的创新性是：a）专注于2014财年部署的同伙服务，b）收集最多5年的纵向数据，以及c）从两种卫生保健系统中合并和分析负责部署后医疗服务的人级医疗保健系统：DOD的军事健康系统（DOD的军事健康系统（MHS）和VHA）和VHA。我们估计，在从部署到阿富汗/伊拉克的返回后的头几个月内，将确定120,000名队列成员在慢性疼痛中被确定。由于分析了包括MHS和VHA服务的纵向数据，因此在系统级别，CAM/非药理PM的广泛性以及阿片类药物使用的普遍性以及返回成员的普遍性的范围内，该应用程序是独特的，可以随着时间的流逝而进行，并在人级使用中，与Aprioids的PM服务较少，在人级别的使用中，与不同的PM进行了改善，或者逐渐改善了Aprios和PM的相关。有利的结果，例如药物使用障碍，合并症的增加或“慢性轨迹”。这些发现将有助于国防部和VHA决策者改善当前的护理模式，并减少受伤和不良服务成员的困扰和发病率。