Development and Evaluation of a Behavioral Pain Management Treatment Program in a Veterans Affairs Medical Center

Abstract

Chronic pain complaints are highly prevalent among Veterans seeking Veterans Affairs health care, and the implementation of effective behavioral health interventions is vital to meet patient needs. Research supports the use of cognitive behavioral therapy for the treatment of chronic pain; however, varying guidelines regarding length of treatment and modality (i.e., group vs. individual) complicate clinical planning and program development. This study aimed to evaluate treatment outcomes and equivalence of 3 variations (12, 10, and 6 weeks of group treatment) of cognitive behavioral therapy for chronic pain using clinical program data collected from Veterans enrolled in Veterans Affairs health services in a large tertiary care setting. Across groups, Veterans showed improvements in negative pain-related thinking and decreases in pain-related disability and distress. In general, patient outcomes regarding pain-related distress and disability for the 6-week group were equivalent or better than the 12- and 10-week groups. Preliminary results support the effectiveness of brief behavioral interventions for chronic pain. The findings have important practical implications, as briefer treatments may offer comparable therapeutic impact as longer, more time-intensive treatment protocols. This study offers a unique examination of treatment development and evaluation processes informed by real-world clinical needs and patient feedback.

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“…Ongoing pain has been an important health issue in veterans, and there has been extensive research on the management of chronic pain in this population, including telemonitoring interventions (Frank, et al, 2015; Stratton, Bender, Cameron, & Pickett, 2015; U.S. Department of Veterans Affairs, 2010).…”

Cognitive behavioural therapy and acceptance and commitment therapy as management strategies for chronic pain

“…Further consideration should also be given to therapist and group effects, as both have been shown to impact clinical outcomes (Huppert, Kivity, Barlow, Gorman, Shear & Woods, 2014). Studies within this review found that a group format actually enhanced positive treatment outcomes, through the way that group members interacted with each other (Holmes et al, 2019;Stratton et al, 2015). Furthermore, Glombiewski et al (2018) argued that greater clinician experience contributed to the large effect size in their outcomes.…”

“…In the present review, it was found that interventions were based on different manuals, but it was not always clear from published studies which aspects of the manuals were used or omitted. For example, Stratton, Bender, Cameron and Pickett (2015) found that group CBT significantly improved pain catastrophizing, pain related disability, and quality of life in US army veterans. However, they used a CBT programme that was specifically designed for treating chronic pain in army veterans.…”

“…However, they used a CBT programme that was specifically designed for treating chronic pain in army veterans. While Stratton et al (2015) provided the sources that were used to design their CBT intervention, it is not clear how closely these were followed, or if any aspect of the protocol was modified to suit the specific population of the study. Similarly, Linden, Scherbe and Cicholas (2014) found that low-back pain specific CBT significantly improved pain intensity, fear of pain, and pain-related avoidance behaviour.…”

“…Similarly, Linden, Scherbe and Cicholas (2014) found that low-back pain specific CBT significantly improved pain intensity, fear of pain, and pain-related avoidance behaviour. In contrast to Stratton et al (2015), Linden et al (2014) were able to outline each session of their intervention and what it entailed (e.g. session one asked patients to report on current coping strategies).…”