Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts

Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) – Protocol for a pragmatic cluster randomized trial

“…This approach is consistent with chronic care models of care [38–42], previous collaborative care and interdisciplinary behavioral approaches to the management of chronic pain [27,35,43–46], the many studies done on the pain coping skills training approach [29,30,47–49], and chronic pain treatment guideline criteria [50–52]. A visual depiction of patient flow through the intervention is shown in Fig.…”

“…The intervention is based on three key principles: 1) Patients learn active pain-coping skills and adapted movement, as distinguished from passive approaches such as pharmacotherapy and/or procedural interventions; 2) there is a focus on patients' improvements in function, rather than solely on pain relief; and 3) interdisciplinary team members make efforts to actively collaborate with and support primary care providers with the goal of enhancing the providers' skills and confidence in working with these patients. Our study builds upon previous multimodal behavioral pain management approaches [27,32,35,74] by conducting the research within a pragmatic trial framework that is focused on applicability, broad inclusion, flexibility in intervention implementation, and attention to the outcomes most meaningful to key stakeholders.…”

“…These approaches combine a variety of therapeutic modalities and typically rely on teams of physicians, behavioral specialists, nurse case managers, and physical therapists to help patients develop skills to actively cope with and self-manage their condition [26–33]. Interdisciplinary care for chronic pain is commonly situated in specialty care settings; however, study findings suggest that such approaches can be effectively delivered in the primary care setting [27,31,32,34,35]. The aim of our cluster-randomized pragmatic trial is to build on these studies by testing a program for its feasibility and sustainability within primary care to help patients adopt self-care and coping skills for managing chronic pain, limit use of opioid medications, and identify exacerbating factors amenable to treatment.…”

Effectiveness of Serious Gaming During Multidisciplinary Rehabilitation for Patients with Complex Chronic Pain or Fatigue: A Natural Quasi-experiment (Preprint)

“…Global prevalence estimates vary with location and case criteria (severity and disability) and are generally considered high (7% -64% for chronic pain, 3% -43% for Tinnitus, 14% -33% for non-cardiac chest pain, and 1% for chronic fatigue syndrome) [3][4][5][6][7][8][9]. In the absence of satisfactory biomedical solutions, biopsychosocial interventions are offered for improving physical and emotional functioning [2,[10][11][12]. A major challenge is to identify particularly (cost)effective therapeutic approaches [13], change techniques [14], and delivery modes (e.g.…”

VHA Pain Research Working Group and VHA Pain Care

“…Kerns, Heapy, and others, which convenes research experts from around VHA to focus on pain research and complements other VHA centers that, although not exclusively devoted to pain research, have developed important pain research programs. Of particular note is research at the primary care level that has provided support for the Stepped Care Model [3][4][5][6][7][8]. VHA's pain research enterprise addresses our society's important need for implementation research, a recognized "donut hole" of the National Institutes of Health research portfolio.…”