SMART Embedded Intervention for Military Postsurgical Engagement Readiness (SEMPER)
Abstract
Optimal musculoskeletal health is essential for active-duty Service Members, who are required to maintain physical fitness to meet intense occupational demands. Knee osteoarthritis (OA) is one of the most common chronic overuse musculoskeletal disorders afflicting U.S. military Service Members, and is among the primary conditions leading to medical separation from active-duty service. Given the magnitude and growth in knee OA prevalence, total knee arthroplasty (TKA) surgeries have surged to historic highs in recent years. Today, TKA is one of the most common inpatient surgeries performed in the U.S., but surgical outcomes can be highly variable and suboptimal. Even after a technically sound TKA, up to 25% of patients are dissatisfied with their surgical outcome, and many patients continue to experience prolonged pain and opioid use after surgery. In fact, TKA increases an opioid-naïve patient’s risk of developing chronic opioid use five-fold, and chronic opioid use leads to medical separation and undermines mission readiness across the Military Health System (MHS). Clearly, novel non-opioid pain management strategies are needed in the MHS. New scientific findings indicate that prolonged pain disrupts functioning in brain regions responsible for self-control, undermining patients’ ability to engage in effective self-management (i.e., self-regulation) of pain, and resulting in avoidance of physical activity, disengagement from physical therapy, and functional impairment. In the absence of effective self-regulation, patients become increasingly dependent on opioids for pain relief. However, chronic opioid use causes changes in stress and reward circuitry in the brain, increasing reactivity to distress and pain and driving opioid dose escalation as a means of preserving a dwindling sense of well-being. Thus, patients become caught in a vicious cycle where the perceived solution (i.e., opioid use) to their problem (i.e., postoperative pain and distress) only magnifies the problem. Interventions are urgently needed to prevent TKA patients’ downward spiral into chronic pain, opioid dependence, and impaired musculoskeletal health. Unfortunately, standard of care during TKA does not address these factors, and current interventions often treat pain, addictive behaviors, and distress in isolation. To fill this gap, this research proposal aims to conduct a pragmatic trial of a novel, adaptive therapeutic approach that integrates brief and intensive mindfulness-based interventions (MBIs) into surgical care pathways within the MHS. MBIs are mental training programs designed to strengthen present-moment attention, awareness, and self-control. Prior research has demonstrated that MBIs increase cognitive performance, stress resilience, and mental health in active-duty Service Members, and our study team has shown that both brief and intensive MBIs can reduce pain and opioid use in civilians. However, we have yet to test whether TKA outcomes can be improved by providing a brief, single-session MBI preoperatively to accelerate postoperative recovery, and providing a more intensive, 8-week week MBI, Mindfulness-Oriented Recovery Enhancement (MORE) to treat chronic pain and opioid use in those patients in need of greater intervention. This research project will help active-duty and retired Service Members with OA undergoing TKA, and will also inform the treatment of Veterans and civilians with similar issues. Should our adaptive mindfulness-based strategy prove to be effective in this trial, within 2 years following completion of the project it could be easily transported into military installations across the U.S. and around the world as part of the MHS Stepped Care Model of Pain Management. A secondary objective of the proposed project is to utilize wearable biometric technology to understand how mindfulness works to create therapeutic change. To accomplish this objective, a wearable device will evaluate Service Members’ ability to
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110328
Entities
People
- Eric L. Garland
Organizations
- United States Army
- University of Utah