The Empower Veterans Program
The EVP emphasizes a shift away from treatment approaches that are passive, ineffective, or dangerous.
ORLANDO — The Empower Veterans Program (EVP) was created by the Atlanta Veterans Administration Medical Center to improve quality of life through active self-care in veterans with chronic pain.1,2 Michael Saenger, MD, FACP, assistant professor of medicine at Emory University School of Medicine and director of the EVP, discussed the program in a presentation at the 2017 annual meeting of the American Academy of Pain Medicine. Joning Dr Saenger in his presentation was Jennifer Gansen, DPT, CPE, the EVP supervisory physical therapist.
The EVP emphasizes a shift away from treatment approaches that are passive, ineffective, or dangerous – such as high-dose opioids, chronic muscle relaxants, and unnecessary surgeries. Instead, participants are encouraged to adopt approaches that are safe, moderately effective, and active, including deep breathing, self-massage, exercise, and mindfulness practices. Passive, evidence-based techniques such as acupuncture, massage, and spinal injections may be used while the patient is transitioning to the active self-care model.
Each of the 10 weekly, 3-hour sessions of group and individual self-care coaching includes 3 different components with a focus on mindfulness. The Whole Health component emphasizes self-care in numerous aspects of one's life, including various mindfulness practices. Acceptance and Commitment Therapy (ACT) helps participants clarify their personal values and learn to use mindfulness to align their actions with those values. Mindful Movement helps them learn to feel aware of and safe in their bodies again, and to understand and alter their pain experience.
The presentation offered a glimpse into the program with examples from the week 4 session. For Whole Health, the agenda includes mindfulness practices and sleep-improving tools; the ACT portion includes a review of values-based goals and exercises designed to explore concepts of barriers and flexibility (eg, considering how flowing water reacts to a barrier such as a rock); and some of the Mindful Movement activities include walking breaks, “Motion Is Lotion Exercises” (MILEs), and posture exercises using pillows and mattresses.
Data from a study of the first 200 EVP graduates, which was discussed in the presentation, show significant reductions in pain catastrophizing, pain interference, and depression, along with a significant increase in physical activity. Other benefits of the program include cost-effectiveness and ease of scalability for improved access, and it is compatible with the Comprehensive Addiction and Recovery Act (CARA) signed into law by President Obama in 2016 to expand the continuum of care in addiction treatment.
Summary and Clinical Applicability
The Empower Veterans Program (EVP) encourages active self-care in veterans with chronic pain, with an emphasis on holistic health, mindfulness practices, and acceptance and commitment therapy to clarify and align with personal values.
- Saenger M, Gansen J. Empower Veterans Program (EVP): Innovative, integrative, self-care well-being training for those with high impact chronic pain. Presented at: the American Academy of Pain Medicine 33rd Annual Meeting; March 16-19, 2017; Orlando, Florida.
- US Department of Veterans Affairs–Atlanta VA Medical Center. Empower Veterans Program. Available at: https://www.atlanta.va.gov/services/Empower_Veterans_Program.asp. Accessed March 17, 2017.