Study Endorses Multipronged Approach to Treating Chronic Pain

Internal Medicine World ReportMay 2015

A study published in JAMA Internal Medicine found a trifecta of analgesics, self-management tools, and cognitive behavioral therapy (CBT) was effective at mitigating veterans' chronic pain.

A study published in JAMA Internal Medicine found a trifecta of analgesics, self-management tools, and cognitive behavioral therapy (CBT) was effective at mitigating veterans’ chronic pain.

Including 121 veterans that served in Operation Enduring Freedom, Operation Iraqi Freedom or Operation New Dawn, Matthew J. Bair, MD, MS and his colleagues introduced them to a stepped-care intervention program. The intervention was multifaceted and included 12 weeks of analgesic treatment, training on pain self-management strategies, and 12 weeks of CBT.

To test the true impact of the regimen, 120 patients underwent usual care for chronic care, which entailed being educated on musculoskeletal pain through handouts, continuing pain medications, clinical visits, specialty referrals, and other typical care.

According to the authors, musculoskeletal pain was chosen as their treatment target since it’s one of the most costly, common, and disabling pain ailments — especially among the military.

The participants, affected by chronic and disabling cervical, lumbar spine or extremity musculoskeletal pain, were prescribed anything from first-line analgesics like acetaminophen and naproxen, to morphine and methadone hydrochloride, long-acting opioids.

After 9 months of treatment, the average Roland Morris Disability Scale Score among stepped-care veterans dropped 3.7 points (95% CI, −4.5 to −2.8), compared to a 1.7-point reduction in the control group (95% CI, −2.6 to −0.9).

Moreover, the investigators used the Graded Chronic Pain Scale and saw a 4.5-point and 11.1-point reduction in the usual care and intervention cohorts, respectively (between-group difference, −6.6 [95% CI, −10.5 to −2.7] points; P = .001).

The benefits of intervention care was further proven through the Pain Interference subscale score of the Brief Pain Inventory, as the authors reported only a baseline 0.9 point drop in the usual care group, whereas stepped-care patients decreased 1.7 points (between-group difference, −0.8 [95% CI, −1.3 to −0.3] points; P = .003).

Furthermore, the team noted there were several strengths to their study and intervention model including using a high-priority group who are disproportionately affected by chronic pain, using a groundbreaking approach, which challenges medical norms, and the testing a telephone-based intervention that allowed nurse care managers (NCMs) to reach patients regardless of location.

“A stepped-care intervention that combined analgesics, self-management strategies, and brief CBT resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in veterans with chronic musculoskeletal pain,” the researchers determined.

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