Neuromodulatory Treatments for Pain Management in Complex TBI Using Mobile Technology
Abstract
Nearly half of combat Veterans with traumatic brain injury (TBI) also experience chronic pain, the combination of the two referred to as “complex TBI.” Chronic pain has a negative impact on physical, emotional, and social well-being in Veterans with TBI. Individuals with TBI are not only more likely to suffer from chronic pain, but their co-occurrence significantly elevates risk of psychiatric comorbidities, drug abuse, aggression, violence, and suicidality. Prescription drugs address chronic pain symptoms but can be abused. When it comes to other traditional treatments, Veterans report barriers including: travel to clinics, stigma, and believing they have to work out problems on their own. These barriers have been associated with low use of traditional treatments. There is a critical need to find alternatives for reducing pain in Veterans with complex TBI. Two alternatives are called “neuromodulatory treatments” because they target changing how the brain processes pain. First, neurofeedback, a type of biofeedback that can train people to gain more control over brain states and increase relaxation, has been used to successfully treat chronic pain. Second, mindfulness, a state of non-judgmental present-focused awareness, has been shown to lower pain intensity and pain-related distress. After minimal training, individuals can practice neurofeedback and mindfulness on their own using mobile technology. These mobile treatments would reduce clinic visits, lower reliance on prescription drugs, minimize stigma, and allow Veterans to work actively on their own treatment. Neurofeedback and mindfulness show promise as transportable, low-cost interventions for reducing pain in Veterans with complex TBI. In this proposal, we aim to test whether mobile neurofeedback and mindfulness training lowers pain symptoms in Veterans with complex TBI. We will randomly assign 300 Veterans with TBI and chronic pain into three groups (100 Veterans per group). Veterans in all groups will receive an iPod Touch with a mobile application (app) installed. Veterans in Group 1 will receive a NeuroSky headset, used to measure brain activity, and the “Mobile Neurofeedback” app; Veterans in Group 2 will receive the “Mindfulness Coach” app, which provides mindfulness training; Veterans in Group 3 (control), will receive the “Relaxing Nature” app, which provides ambient sounds and nature scenes for unstructured relaxation. Veterans will be instructed to use their respective mobile apps independently 10 minutes a day, 4 times a week, for 12 weeks. Over the 12 weeks, research staff will visit Veterans’ homes twice to reinforce training, troubleshoot technical problems, and collect usage data. Staff will also contact participants by phone twice to provide technical support and collect usage data. We will interview Veterans, measure clinical outcomes, and measure brain activity with an electroencephalograph (EEG) at 0, 3, and 6 months. We expect that Veterans in the neurofeedback and mindfulness groups will have significantly reduced pain symptoms at the end of 3 months, with long-term improvement persisting at 6 months. We hypothesize reductions in pain symptoms will correlate with changes in brainwave activity. Given links between pain and negative outcomes, we will also examine outcomes related to drug abuse, violence, and suicidality. Finally, given these interventions may affect other biological systems, we will explore whether neurofeedback and mindfulness improve cardiovascular health by measuring heart rate variability (HRV.) If successful, this study will identify a low-cost, transportable, user-friendly, and effective approach for military Service members and Veterans with complex TBI to manage pain symptoms. Implementing neurofeedback and mindfulness through mobile devices would reduce reliance on pharmacological treatments and overcome many barriers of traditional non-pharmacological treatments because they can be readily
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710591
Entities
People
- Eric B. Elbogen
Organizations
- Duke University
- United States Army