A stepped-care strategy improved function and decreased pain severity for military veterans returning from areas of war, according to a study published online.
Matthew Bair, MD, a VA and Regenstrief Institute investigator who led the randomized controlled ESCAPE trial, and colleagues studied 241 veterans of Operations Enduring Freedom, Iraqi Freedom and New Dawn who suffer from musculoskeletal pain of the back, knee, neck or shoulder.
The researchers developed a two-step program combining analgesics, self-management strategies and cognitive behavioral therapy.
The first step involved 12 weeks of medication treatment ranging from acetaminophen or naproxen sodium to opioids, coupled with pain self-management strategies such as deep breathing and other relaxation techniques. Step two involved 12 weeks of cognitive behavioral therapy drawing upon evidence-based psychological treatments for both pain and depression.
The ESCAPE program was provided over the telephone by nurse care managers. They worked with the veterans to help counter maladaptive thought and to help them better understand that while they might not be able to continue rigorous activities that they had enjoyed before deployment, a substitute activity like swimming might be achievable and decrease their pain.
Those who received the two-step ESCAPE program saw improvement in their function and a decrease in their pain severity and pain interference, or how pain interferes with mood, physical activity, work, social activity, relations with others, sleep and enjoyment of life.
Study patients randomized to usual care received educational handouts on musculoskeletal pain and were advised to discuss their pain with their physicians. These patients continued medications, clinic visits, specialty referrals and other care as usual.
The intervention produced at least a 30% improvement in pain-related disability.
1. Bair M, et al. JAMA Intern Med. 2015; doi:10.1001/jamainternmed.2015.97.