Empower Veterans Program (EVP): a chronic pain management program demonstrates positive outcomes among veterans

Abstract

Background Chronic pain is a highly prevalent health condition among veterans. Traditional pharmacological interventions present unique challenges for chronic pain management including prescription opioid addiction and overdose. In alignment with the 2016 Comprehensive Addiction and Recovery Act and VA’s Stepped Care Model to meet veterans’ pain management needs, the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) funded an enterprise-wide initiative to implement a Step 3 integrated tele-pain program: Empower Veterans Program (EVP). EVP provides veterans with chronic pain self-care skills using a whole health driven approach to pain management. Objectives The Comprehensive Addiction and Recovery Act prompted the strategic approach to offer non-pharmacological options to meet veterans’ pain management needs. EVP, a 10-week interdisciplinary group medical appointment, leverages Acceptance and Commitment Therapy, Mindful Movement, and Whole Health to provide veterans with chronic pain self-care skills. This evaluation was conducted to describe participant characteristics, graduation, and satisfaction rates; and assess pre-post patient-reported outcomes (PRO) associated with EVP participation. Methods A sample of 639 veterans enrolled in EVP between May, 2015 and December, 2017 provided data to conduct descriptive analyses to assess participant demographics, graduation, and satisfaction rates. PRO data were analyzed using a within-participants pre-post design, and linear mixed-effects models were used to examine pre-post changes in PRO. Results Of 639 participants, 444 (69.48%) graduated EVP. Participant median program satisfaction rating was 8.41 (Interquartile Range: 8.20–9.20). Results indicate pre-post EVP improvements (Bonferroni-adjusted p < .003) in the three primary pain outcomes (intensity, interference, catastrophizing), and 12 of 17 secondary outcomes, including physical, psychological, health-related quality of life (HRQoL), acceptance, and mindfulness measures. Discussion Data suggest that EVP has significant positive outcomes in pain, psychological, physical, HRQoL, acceptance, and mindfulness measures for veterans with chronic pain through non-pharmacological means. Future evaluations of intervention dosing effect and long-term effectiveness of the program is needed.

Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization

“…Program evaluation for the in-person EVP program has demonstrated feasibility and acceptability through both completion and satisfaction rates, as well as promising improvements in primary pain outcomes of intensity, interference, and catastrophizing from pre-to-post EVP. 27 Improvements have also been noted for acceptance (activity engagement despite pain, willingness to experience pain), depression, anxiety, sleep disturbance, mindfulness (nonreactivity to negative thoughts and emotions, observing their experiences), fatigue, adoption of healthy self-care, greater positivity and empowerment to participate in life, changing medication use, and reduction in total mortality among veterans with chronic pain and opioid use. [62][63][64][65]…”

Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program

“…The effectiveness of integrated interdisciplinary chronic pain programs on improving multi-dimensional pain outcomes is well-established in VA settings [ 32 – 36 ]. The Empower Veterans Program (EVP) is a non-pharmacological interdisciplinary chronic pain rehabilitation program that integrates ACT, its core behavioral therapy, with mindful movement (MM), and whole health (WH) [ 36 ]. MM within EVP teaches veterans to observe and accept mind–body experiences while emphasizing an open, nonjudgmental attitude [ 37 ].…”

“…Veterans also reported high program satisfaction [ 40 ]. A larger pre-post quality management project [ 36 ] found clinical small-to-medium effect size improvements in primary outcomes including pain intensity, interference, and catastrophizing. Small-to-medium effect size improvements were also observed for 12 of 17 secondary outcomes including physical (fatigue), psychological (anxiety, depression, sleep disturbance), and HRQoL (environmental, physical, psychological, social) domains.…”

“…Interestingly, pre-post clinical improvements did not differ between veterans that graduated from EVP compared to non-graduates. Veterans also provided high favorability ratings for EVP [ 36 ]. Findings from these evaluations suggest that EVP is a workable non-pharmacological interdisciplinary rehabilitation option for veterans with chronic pain [ 36 , 39 , 40 ].…”

“…Veterans also provided high favorability ratings for EVP [ 36 ]. Findings from these evaluations suggest that EVP is a workable non-pharmacological interdisciplinary rehabilitation option for veterans with chronic pain [ 36 , 39 , 40 ].…”