The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative

Abstract

Objective Despite empirical support for interdisciplinary pain rehabilitation programs improving functioning and quality of life, access to this treatment approach has decreased dramatically over the last 20 years within the United States but has grown significantly in the Department of Veterans Affairs (VA). Between 2009 and 2019, VA pain rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities increased 10-fold in the VA, expanding from two to 20. The aim of this collaborative observational evaluation was to examine patient outcomes across a subset of six programs at five sites. Methods Outcomes were assessed using agreed-upon measures of patient-reported pain intensity, pain interference across various domains, pain catastrophizing, and sleep. Results A total of 931 patients enrolled in the selected VA interdisciplinary pain programs, with 84.1% of participants completing the full course of treatment. Overall, all programs showed significant improvements from pretreatment to posttreatment in nearly all patient-reported outcomes. The effect sizes ranged from medium to large. Notably, the results demonstrate that positive outcomes were typical despite differences in structure and resources across programs. Conclusions The adverse impacts of opioid use have highlighted the importance of chronic pain treatment approaches that emphasize team-based care focused on functional improvements. This study represents the first and largest analysis of outcomes across chronic pain rehabilitation programs and demonstrates the need for increased access to similar comprehensive approaches to pain management across the health care system. Further, it suggests that a variety of structures may be effective, encouraging flexibility in adopting this interdisciplinary approach.

Insomnia symptoms and chronic pain: Outcomes of an interdisciplinary pain rehabilitation program

“…Recently, a study of 6 IPRPs within the Veteran's Affairs Healthcare System demonstrated a statistically significant reduction in insomnia symptoms at program discharge. 14 Craner et al 11 also documented statistically significant reductions in insomnia severity following IPRP participation. Another study reported that total sleep time increased over the course of IPRP treatment and that improvement in sleep was related to improvement in pain.…”

“…Prior research evaluating the impact of IPRP participation on insomnia symptoms has also yielded mixed results. Recently, a study of 6 IPRPs within the Veteran’s Affairs Healthcare System demonstrated a statistically significant reduction in insomnia symptoms at program discharge 14 . Craner et al 11 also documented statistically significant reductions in insomnia severity following IPRP participation.…”

“…8,9 There is well-documented support for the effectiveness of these programs in improving pain, functioning, and emotional distress. [10][11][12][13][14] A growing body of literature indicates that IPRPs can confer treatment benefits for patients presenting with a range of comorbid problems, including those with depression, 15,16 trauma histories, 17,18 and obesity, 19 even when those problems are not directly targeted in treatment. Research is less clear whether this is the case for patients with insomnia.…”

“There’s a huge benefit just to know that someone cares:” a qualitative examination of rural veterans’ experiences with TelePain

“…TelePain specialists are physically located in a single VA medical center at one of two divisions (Seattle, WA or Tacoma, WA). TelePain is built on the model of interdisciplinary, team-based pain management [ 15 ]. TelePain’s outpatient rehabilitation-focused services are based on a biopsychosocial model of chronic pain.…”

Treatment of Insomnia within an Interdisciplinary Pain Rehabilitation Program: A Randomized Trial

“…These comprehensive, biopsychosocial programs emphasize functional restoration and typically involve physical and occupational therapy, medical visits, and mental health visits. A large body of research supports the claim that IPRPs improve pain, functioning, and quality of life among those with chronic pain ( Craner et al., 2020 ; Gilliam et al., 2018 ; Huffman et al., 2017 ; Murphy et al., 2021 ). IPRPs have also demonstrated significant improvements in insomnia symptoms ( Craner et al., 2020 ).…”