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Two-step Pain Management Strategy Improves Function and Reduces Pain Severity in Veterans

Pain ManagementPain is a disabling condition that interferes with routine activities and a serious issue among veterans, many of whom had multiple, often lengthy deployments in difficult environments.

A new study reports that a two-step care strategy to manage chronic pain in US Military veterans improved function and reduced pain severity. This treatment approach produced at least 30% improvement in pain-related disability, which lasted for about nine months, says the study. The Evaluation of Stepped Care for Chronic Pain (ESCAPE) study was conducted by researchers at Veterans Affairs [VA] Medical Center in Indianapolis, the Regenstrief Institute, and the Indiana University School of Medicine. The results were published online in JAMA Internal Medicine (March 9, 2015 issue).

Step 1 of the care strategy comprised 12 weeks of analgesic treatment and optimization (based on an algorithm) as well as self pain management strategies. It included medication treatment such as acetaminophen or naproxen sodium and opioids coupled with pain self-management strategies such as deep breathing and other relaxation techniques. Step 2 comprised 12 weeks of cognitive-behavioral therapy involving evidence-based psychological treatments for both aches and depression.

The researchers evaluated 241 veterans of the Iraq and Afghanistan wars who suffered long-term musculoskeletal pain of the back knee, neck or shoulders. The mean age of participants was 36.7 years and more than 88.4% were men.
Up to 121 patients were randomly assigned to the stepped-care treatment and 120 to usual care. The usual care group patients were given educational handouts related to musculoskeletal pain and were advised to discuss their symptoms with their physicians, and maintained their usual medications and office visits. Both the groups were subjected to similar baseline ache measures.

When compared to the usual care group, the patients who got stepped-care treatment experienced the following benefits:

  • significant decrease in all pain severity
  • 30 percent improvement in pain-related disability
  • decrease in pain interference – how pain interferes with mood, physical activity, work, social activity, relations with others, sleep and enjoyment of life

The researchers noted that the decrease in pain intensity and improvement in pain related disability lasted for at least nine months.

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