Bright Light Treatment At Home To Manage Chronic Pain In U.S. Veterans
Condition: Chronic Low Back Pain
MeSH terms: Low Back Pain; Chronic Pain
Study type: Interventional

Summary: 
      Nearly 50% of U.S. veterans report they experience pain on a regular basis. This chronic pain
      often co-occurs with other disorders including post-traumatic stress disorder (PTSD),
      depression, anxiety and insomnia. A common approach to treating chronic pain is opioid
      analgesics, which are not always effective, and increasingly associated with abuse and
      misuse. Thus, there is an urgent need to develop readily available, safe, and practical
      complementary nonpharmacological approaches to manage chronic pain in U.S. veterans. Chronic
      pain is a multidimensional phenomenon, inter-related with many factors, including negative
      mood and poor sleep. The central circadian clock, in the suprachiasmatic nucleus in the
      hypothalamus, is well recognized to regulate both mood and sleep, and even small delays
      (shifts later) in circadian/sleep timing are associated with depression and disrupted sleep.
      These results suggests that later circadian/sleep timing may be a modifiable risk factor for
      pain. Thus, a self-administered morning bright light treatment at home may be a potentially
      efficacious adjunctive strategy for managing chronic pain. This R34 grant will develop a
      morning bright light treatment to help manage chronic pain and improve PTSD symptoms,
      depression, anxiety and sleep in U.S. veterans. Patients will have 7 baseline days at home,
      followed by a baseline pain sensitivity assessment and home circadian phase assessment (dim
      light melatonin onset). Following an instructional home visit, patients will then
      self-administer morning bright light treatment for 6 days, followed by reassessments of pain
      sensitivity and circadian phase. Assessments will be repeated after another 7 days of morning
      bright light treatment. Pain, mood and sleep (wrist actigraphy) will be assessed daily
      throughout baseline and treatment. Pain, mood and sleep will also be rated by veterans daily
      during a 1 month follow up after cessation of light treatment. This study will determine the
      feasibility, acceptability and efficacy of bright light treatment in a sample of U.S.
      veterans experiencing chronic low back pain.
    

Detailed description: 
      Almost 50% of U.S. veterans report they experience pain on a regular basis. This chronic pain
      often co-occurs with other disorders including post-traumatic stress disorder (PTSD),
      depression, anxiety and insomnia. A common approach to treating chronic pain is opioid
      analgesics, which are not always effective, and increasingly associated with abuse and
      misuse. Thus, there is an urgent need to develop readily available, safe, and practical
      complementary nonpharmacological approaches to manage chronic pain in U.S. veterans. Chronic
      pain is a multidimensional phenomenon, inter-related with many factors, including negative
      mood and poor sleep. The central circadian clock, in the suprachiasmatic nucleus in the
      hypothalamus, is well recognized to regulate both mood and sleep, and even small delays
      (shifts later) in circadian/sleep timing are associated with depression and disrupted sleep.
      These results suggests that later circadian/sleep timing may be a modifiable risk factor for
      pain. Thus, a self-administered morning bright light treatment at home may be a potentially
      efficacious adjunctive strategy for managing chronic pain. This R34 grant will develop a
      morning bright light treatment to help manage chronic pain and improve PTSD symptoms,
      depression, anxiety and sleep in U.S. veterans. Patients will have 7 baseline days at home,
      followed by a baseline pain sensitivity assessment and home circadian phase assessment (dim
      light melatonin onset). Following an instructional home visit, patients will then
      self-administer morning bright light treatment for 6 days, followed by reassessments of pain
      sensitivity and circadian phase. Assessments will be repeated after another 7 days of morning
      bright light treatment. Pain, mood and sleep (wrist actigraphy) will be assessed daily
      throughout baseline and treatment. Pain, mood and sleep will also be rated by veterans daily
      during a 1 month follow up after cessation of light treatment. This study will determine the
      feasibility, acceptability and efficacy of bright light treatment in a sample of U.S.
      veterans experiencing chronic low back pain.
    

Intervention name(s): Bright light
Intervention type(s): Device
Intervention description(s): The purpose of this R34 Pilot and Feasibility study is to develop a morning bright light treatment to help manage chronic pain and improve PTSD symptoms, mood, and sleep in US veterans. Veterans will have 7 baseline days at home, followed by a baseline pain sensitivity assessment and baseline home circadian phase assessment (dim light melatonin onset). Following an instructional home visit, patients will then self-administer morning bright light treatment for 6 days, followed by reassessments of pain sensitivity and home circadian phase. This will be repeated after a further 7 days of morning bright light treatment. The Patient Reported Outcomes Measurement Information System (PROMIS) will also be administered at every lab visit. Additionally, pain and mood (electronic diaries) and sleep (wrist actigraphy) will be assessed daily throughout baseline and treatment. Pain, mood and sleep will also be self-reported daily during a 1 month follow up after cessation of light treatment.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science