Advances in pain management for Veterans: Current status of research and future directions

Kerns, Robert D.; Heapy, Alicia

doi:10.1682/jrrd.2015.10.0196

Cited by 5 publications

(9 citation statements)

References 9 publications

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“…Additionally, at end of treatment the PTSD group when compared to the no PTSD group had made statistically significant reductions on the CORE-10 and on the IES-6 (see Table 5). However, there was substantial missing data at day 10 in both PTSD and No PTSD groups, 31 and 23, respectively, mainly due to administrative error [12], work [11], pain flare-up [8], and post-traumatic stress symptoms [19]. Figure 1 shows reliable changes [41] in confidence in activity despite pain (PSEQ) and pain catastrophising (PCS); those making reliable improvement far outnumbered those who reliably worsened, only a few of the latter for each outcome.…”

Section: Resultsmentioning

confidence: 99%

“…Health services often lack the expertise to assess and manage pain conditions in the veteran population [19] or to fully understand the complexities of comorbid chronic pain and PTSD [1,10]. Veterans with both chronic pain and post-traumatic stress symptoms may be offered the treatments in sequence, but there are differences in clinical opinion on the best order of treatment.…”

Section: Introductionmentioning

confidence: 99%

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Military veterans with and without post-traumatic stress disorder: results from a chronic pain management programme

Merwe

Brook

Fear

et al. 2020

Scandinavian Journal of Pain

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Background and aimsThere is very little published evaluation of the treatment of military veterans with chronic pain, with or without post-traumatic stress disorder. Few clinical services offer integrated treatment for veterans with chronic pain and PTSD. Such veterans experience difficulty in accessing treatment for either condition: services may consider each condition as a contraindication to treatment of the other. Veterans are therefore often passed from one specialist service to another without adequate treatment. The veteran pain management programme (PMP) in the UK was established to meet the needs of veterans suffering from chronic pain with or without PTSD; this is the first evaluation.MethodsThe PMP was advertised online via veteran charities. Veterans self-referred with accompanying information from General Practitioners. Veterans were then invited for an inter-disciplinary assessment and if appropriate invited onto the next PMP. Exclusion criteria included; current severe PTSD, severe depression with active suicidal ideation, moderate to severe personality disorder, or who were unable to self-care in the accommodation available. Treatment was by a team of experienced pain management clinicians: clinical psychologist, physiotherapist, nurse, medical consultant and psychiatrist. The PMP was delivered over 10 days: five residential days then five single days over the subsequent 6 months. The PMP combines cognitive behavioural treatment, which has the strongest evidence base, with more recent developments from mindfulness-based CBT for pain and compassion-focused therapy. Standard pain management strategies were adapted to meet the specific needs of the population, recognising the tendency to use demanding activity to manage post-traumatic stress symptoms. Domains of outcome were pain, mood, function, confidence and changes in medication use.ResultsOne hundred and sixty four military veterans started treatment in 19 programmes, and 158 completed. Results from those with high and low PTSD were compared; overall improvements in all domains were statistically significant: mood, self-efficacy and confidence, and those with PTSD showed a reduction (4.3/24 points on the IES-6). At the end of the programme the data showed that 17% reduced opioid medication and 25% stopped all opioid use.ConclusionsVeterans made clinically and statistically significant improvements, including those with co-existing PTSD, who also reduced their symptom level. This serves to demonstrate the feasibility of treating veterans with both chronic pain and PTSD using a PMP model of care.ImplicationsMilitary veterans experiencing both chronic pain and PTSD can be treated in a PMP adapted for their specific needs by an experienced clinical team.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Military veterans with and without post-traumatic stress disorder: results from a chronic pain management programme

Merwe

Brook

Fear

et al. 2020

Scandinavian Journal of Pain

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“…Military and veteran populations worldwide report particularly high rates of chronic pain and pain interference. [7][8][9] As such, pain management has become a priority for the U.S. Departments of Defense (DOD) and Veterans Affairs (VA), which have established an integrated stepped care model of pain management with clinical pathways that promote the use of NPTs, including complementary and integrative health approaches.…”

Section: Introductionmentioning

confidence: 99%

“…Although many people experience chronic pain, certain populations are at greater risk, including severe, debilitating chronic pain. Military and veteran populations worldwide report particularly high rates of chronic pain and pain interference 7‐9 . As such, pain management has become a priority for the U.S.…”

Section: Introductionmentioning

confidence: 99%

Justice and equity in pragmatic clinical trials: Considerations for pain research within integrated health systems

Ali

Davis

Burgess

et al. 2021

Learning Health Systems

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Introduction Pragmatic clinical trials (PCTs) can overcome implementation challenges for bringing evidence‐based therapies to people living with pain and co‐occurring conditions, providing actionable information for patients, providers, health systems, and policy makers. All studies, including those conducted within health systems that have a history of advancing equitable care, should make efforts to address justice and equity. Methods Drawing from collective experience within pragmatic pain clinical trials networks, and synthesizing relevant literature, our multidisciplinary working group examined challenges related to integrating justice and equity into pragmatic pain management research conducted in large, integrated health systems. Our analysis draws from military and veteran health system contexts but offers strategies to consider throughout the lifecycle of pragmatic research more widely. Results We found that PCTs present a unique opportunity to address major influences on health inequities by occupying a space between research, healthcare delivery, and the complexities of everyday life. We highlight key challenges that require attention to support complementary advancement of justice and equity via pragmatic research, offering several strategies that can be pursued. Conclusions Efforts are needed to engage diverse stakeholders broadly and creatively in PCTs, such as through dedicated health equity working groups and other collaborative relationships with stakeholders, to support robust and inclusive approaches to research design and implementation across study settings. These considerations, while essential to pain management research, offer important opportunities toward achieving more equitable healthcare and health systems to benefit people living with pain and co‐occurring conditions.

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“…As described by Drs. Kerns and Heapy in their Editorial [1], the development of the VHA's pain research enterprise has evolved over many years, with a particular focus on understanding the factors, including combined treatments, that affect the course and outcome of pain care for Veterans and inform clinical policy. The articles herein provide a sample of the breadth and sophistication of the VHA pain research enterprise in several domains: observational studies that help us understand the biopsychosocial factors influencing the development and perpetuation of chronic pain and pain treatment outcomes in Veterans with chronic pain and its comorbidities, such as posttraumatic stress disorder; investigations of the effects of exercise on pain sensitivity; and studies of the efficacy of multimodal treatments, e.g., combining exercise with medications to improve physical capacity.…”

mentioning

confidence: 99%

VHA Pain Research Working Group and VHA Pain Care

Gallagher¹

2016

J Rehabil Res Dev

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Advances in pain management for Veterans: Current status of research and future directions

Cited by 5 publications

References 9 publications

Military veterans with and without post-traumatic stress disorder: results from a chronic pain management programme

Military veterans with and without post-traumatic stress disorder: results from a chronic pain management programme

Justice and equity in pragmatic clinical trials: Considerations for pain research within integrated health systems

VHA Pain Research Working Group and VHA Pain Care

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