Bright Light Treatment At Home To Manage Chronic Pain In U.S. Veterans

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.