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Mindfulness-Based Interdisciplinary Pain Management Program for Complex Polymorbid Pain in Veterans: A Randomized Clinical Trial

Published:August 05, 2022DOI:https://doi.org/10.1016/j.apmr.2022.06.012

      Abstract

      Objective

      To evaluate the effects of interdisciplinary pain management on pain-related disability and opioid reduction in polymorbid pain patients with two or more comorbid psychiatric conditions.

      Design

      Two-arm randomized clinical trial testing a three-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 with moderate (or worse) levels of pain-related disability, depression, anxiety, and/or PTSD 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 three-week, interdisciplinary pain management program guided by a structured manual; Comparison arm – usual care in a large VA 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 (i.e., 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), DoD (Department of Defense), FORT-A (Functional Orthopedic Rehabilitation Treatment), GAD-7 (7-item generalized anxiety disorder screener), GLMM (generalized linear mixed model(s)), IPMC (interdisciplinary pain management center), ITT (intent-to-treat), MEMS (Medication Event Monitoring System), ODI (Oswestry Disability Index), PCL-5 (PTSD Checklist for the DSM-5), PHQ-9 (9-Item Patient Health Questionnaire depression screener), PRIME-MD (Primary Care Evaluation of Mental Disorders), PTSD (posttraumatic stress disorder), SMD (standardized mean difference), TAU (treatment as usual), TLFB (Timeline Follow-back Interview), TBI (traumatic brain injury), Tx (treatment), VA (Department of Veterans Affairs)
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