Evidence-Based Pain Intervention for Veterans: Leveraging Mobile &Social Media

Johnson, Sara

Abstract

Chronic musculoskeletal pain creates a significant public health burden. Veterans are disproportionately affected by chronic musculoskeletal pain, and in particular, chronic low back pain (CLBP). The frequency and extent of co-occurrence of pain and PTSD, pain and Traumatic Brain Injury (TBI), and all three conditions (Post-deployment Multi-symptom Disorder (PMD)) can complicate and reduce the effectiveness of treatment for pain. The 2011 Institute of Medicine Blueprint for Relieving Pain in America calls for the promotion of self- management;reducing disparities among vulnerable subgroups (including Veterans);and the tailoring of pain care to each patient. Proponents of integrated treatment for PMD or the co-occurrence of pain with either TBI or PTSD are advocating for delivery of interventions that address multiple conditions. The proposed research represents an innovative response to those recommendations in that it will develop and examine the feasibility, acceptability, and preliminary effects of Sx3: Self Management of Pain, Sleep, &Stress Management a theoretically-grounded, mobile-optimized, Internet-based, interactive pain self-management program for chronic musculoskeletal pain. Unlike any existing pain intervention, Sx3: 1) is tailored specifically for Veterans'readiness to adopt self-management and preference for pain management strategies;2) incorporates two of the core components of promising integrated treatments for PMD that are appropriate for Veterans with co-morbidities: sleep hygiene and stress management (relaxation training);and 3) leverages social networking, gaming principles, and SMS messaging to increase engagement and retention. Developed in collaboration with national pain self-management expert Dr. Robert Kerns, the computer- tailored intervention (CTI) will include a dynamic personal activity center, principles of gaming for health, social networking features, and optional text messages. Extensive end user and stakeholder input will ensure Sx3 is designed for rapid dissemination. Participants for formative focus groups (n=60);usability testing (n=20);and a pilot test (n=50) will be recruited from VA Connecticut Healthcare System. Formative focus group feedback will be combined with expert input to develop a prototype of an engaging self-management program tailored to readiness to adopt and preference for pain coping skills that incorporates sleep hygiene and stress management. Usability testing will allow the prototype to be refined before a 30-day pilot. Pilot participants will provide quantitative and qualitative acceptability data, and utilization data wil be examined. Pre-post comparisons of pain intensity;physical and emotional functioning;Patient Global Impression of Change;and readiness to adopt pain coping skills will provide preliminary data on the effects of the program. These data will inform program modifications needed to proceed with the Phase II effectiveness trial. Phase II will provide the impetus for commercialization of a cost-effective, evidence-based, population-based program that has the potential to improve pain self-management, functioning, and well-being.

Public Health Relevance

Chronic pain, and in particular, chronic musculoskeletal pain is all too common and imposes enormous costs on patients, society, and the health care system. The proposed research will develop and test a pain self- management program that 1) provides feedback uniquely matched to an individual's readiness to use helpful pain coping skills, improve sleep hygiene, and manage stress;2) can be used on any computer or mobile device;3) interfaces with social networking sites;4) includes personalized text messages;and 5) uses principles of gaming for health to engage users. This computer tailored intervention offers a cost-effective, science-based, and easily deliverable solution to entire populations to increase self-management, reduce pain, and improve functioning and well-being.