Abstract
Objective
To evaluate the effects of interdisciplinary pain management on pain-related disability
and opioid reduction in polymorbid pain patients with 2 or more comorbid psychiatric
conditions.
Design
Two-arm randomized controlled trial testing a 3-week intervention with assessments
at pre-treatment, post-treatment, 6-month, and 12-month follow-up.
Setting
Department of Veterans Affairs medical facility.
Participants
103 military veterans (N=103) with moderate (or worse) levels of pain-related disability,
depression, anxiety, and/or posttraumatic stress disorder randomly assigned to usual
care (n=53) and interdisciplinary pain management (n=50). All participants reported
recent persistent opioid use. Trial participants had high levels of comorbid medical
and mental health conditions.
Interventions
Experimental arm—a 3-week, interdisciplinary pain management program guided by a structured
manual; comparison arm—usual care in a large Department of Veterans Affairs medical
facility.
Main Outcome Measures
Oswestry Disability Index (pain disability); Timeline Followback Interview and Medication
Event Monitoring System (opioid use). Analysis used generalized linear mixed model
with all posttreatment observations (posttreatment, 6-month follow-up, 12-month follow-up)
entered simultaneously to create a single posttreatment effect.
Results
Veterans with polymorbid pain randomized to the interdisciplinary pain program reported
significantly greater decreases in pain-related disability compared to veterans randomized
to treatment as usual (TAU) at posttreatment, 6-month, and 12-month follow-up. Aggregated
mean pain disability scores (ie, a summary effect of all posttreatment observations)
for the interdisciplinary pain program were -9.1 (95% CI: -14.4, -3.7, P=.001) points lower than TAU. There was no difference between groups in the proportion
of participants who resumed opioid use during trial participation (32% in both arms).
Conclusion
These findings offer the first evidence of short- and long-term interdisciplinary
pain management efficacy in polymorbid pain patients, but more work is needed to examine
how to effectively decrease opioid use in this population.
Keywords
List of abbreviations:
CIH (Complementary and Integrative Health), FORT-A (Functional Orthopedic Rehabilitation Treatment), GAD-7 (7-item generalized anxiety disorder screener), IPMC (interdisciplinary pain management center), ODI (Oswestry Disability Index), PTSD (posttraumatic stress disorder), SMD (standardized mean difference), TAU (treatment as usual), TLFB (Timeline Follow-back Interview), TBI (traumatic brain injury), VA (Department of Veterans Affairs)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 05, 2022
Accepted:
June 21,
2022
Received in revised form:
June 15,
2022
Received:
January 27,
2022
Footnotes
The work described in this manuscript was funded under an award from the National Center for Complementary and Integrative Health (Award R01 AT008422-01; PI: D. McGeary).
Trial Registration: This trial was registered on ClinicalTrials.gov on January 15, 2016; ClinicalTrials.gov Identifier: NCT02657317; the first participant was enrolled in June 2016.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine.
