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

https://doi.org/10.1016/j.apmr.2022.06.012Get rights and content

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.

Section snippets

Methods

The present two-arm randomized controlled trial (ClinicalTrials.gov identifier NCT02657317) was reviewed and approved by the joint Institutional Review Board of the University of Texas Health Science Center San Antonio and the South Texas Veterans Health Care System. Participants were recruited through the San Antonio VA Polytrauma Rehabilitation Center and provided written informed consent before participation. The trial was registered in January 2016; the first participant was enrolled in

Demographics

The trial ceased when target enrollment was completed. Demographics for the study sample are described in table 1. There was significant variability between the 2 groups across numerous baseline variables, and the investigators chose a standardized mean difference (SMD) threshold of 0.25 to consider a baseline variable for sensitivity analysis.

The randomized sample included 53 participants assigned to TAU and 50 participants assigned to FORT-A (as shown in figure 1). FORT-A participants

Discussion

Overall, the present study revealed that an interdisciplinary pain management program can produce significant and sustained improvements in pain-related disability compared to comprehensive standard VA care in a sample of 103 veterans with service-related chronic musculoskeletal pain and polymorbid depression, PTSD, and persistent opioid use. Participants in this trial appeared to respond well to the FORT-A intervention and exit interviews with study veterans revealed a high level of

Conclusions

In conclusion, the present study represents the first deliberate test of long-term outcomes for interdisciplinary pain management in a sample of veterans with polymorbid musculoskeletal pain, trauma, psychiatric conditions, and persistent opioid use. The outcomes of this clinical trial suggest that veterans with pain-related psychiatric comorbidities receive comparable short- and long-term benefits from interdisciplinary pain management compared to chronic pain sufferers without polymorbidity,

Acknowledgments

The authors would like to acknowledge Mr. Ray Aguilar for technical assistance, Ms. Deanne Hargita for assistance with regulatory approvals, Ms. Briana Cobos for assistance with data organization, and Mrs. Julie Collins for assistance editing this manuscript. The views expressed herein are solely those of the authors and do not represent an endorsement by or the official policy or position of the Department of Veterans Affairs, the National Institutes of Health, or the U.S. Government. The data

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  • Cited by (1)

    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.

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