Program Profile

Restoring Function in Veterans With Complex Chronic Pain

Fed Pract. 2017 October;34(10):42-47

References

1. International Association for the Study of Pain. IASP taxonomy. https://www.iasp-pain.org/Taxonomy#Pain. Updated May 22, 2012. Accessed August 31, 2017.

2. Nahin RL. Severe pain in veterans: the effect of age and sex, and comparisons with the general population. J Pain. 2017;18(3):247-254.

3. U.S. Census Bureau. 2011-2015 American community services 5-year estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_5YRB21002&prodType=table. Accessed August 31, 2017.

4. U.S. Census Bureau, population division. Annual estimates of the resident population: April 1, 2010 to July 1, 2016. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview .xhtml?pid=PEP_2016_PEPANNRES&SPC=pt. Accessed August 31, 2017.

5. Hogan ME, Taddio A, Katz J, Shah V, Krahn M. Health utilities in people with chronic pain using a population level survey and linked health care administrative data. Pain. 2017;158(3):408-416.

6. Kerns RD, Otis J, Rosenberg R, Reid MC. Veterans reports of pain and associations with ratings of health, health risk-behaviors, affective distress and use of the healthcare system. J Rehabil Res Dev. 2003;40(5):371-379.

7. Gallagher RM. Advancing the pain agenda in the veteran population. Anesthesiol Clin. 2016;34(2):357-378.

8. U.S. Department of Veterans Affairs. Analysis of VA health care utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans. https://www.publichealth.va.gov/docs/epidemiol ogy/healthcare-utilization-report-fy2015-qtr3.pdf. Published January 2017. Accessed August 31, 2017.

9. National Academies of Science. Institute of Medicine: Relieving pain in America: a blueprint for transforming prevention care, education, and research. https://iprcc.nih.gov/docs/032712_mtg _presentations/iom_pain_report_508comp.pdf. Published June 29, 2011. Accessed August 31, 2017.

10. U.S. Department of Veterans Affairs. Transforming VA pain care. https://www.va.gov/painmanagement/Updated August 17, 2017. Accessed August 31, 2017.

11. American Pain Society. Interdisciplinary pain management. http://americanpainsociety.org/uploads/about/position-statements/interdisciplinary-white -paper.pdf. Accessed August 31, 2017.

12. Stanos S. Focused review of interdisciplinary pain rehabilitation programs for chronic pain management. Curr Pain Headache Rep. 2012;16(2):147-152.

13. Cosio D, Lin EH. (538) Efficacy of an outpatient, multidisciplinary VA pain management clinic: findings from a one-year outcome study. Pain. 2014;15(4):S110.

14. Cosio D, Lin EH. Effects of a pain education program in complementary and alternative medicine treatment utilization at a VA medical center. Complement Ther Med. 2015;23(3):413-422.

15. Clark ME, Gironda RJ, Young RW. Development and validation of the pain outcomes questionnaire-VA. J Rehabil Res Dev. 2003;40(5)-381-395.

Program Effectiveness

Program effectiveness is measured using the POQ-VA (Pain Outcomes Questionnaire-VA). The POQ results and participant feedback are used to ensure ongoing program evaluation and improvement. This outcome measure was selected as the POQ-VA evaluates intervention effectiveness of all the major pain outcomes domains. This questionnaire was developed and validated by the VA.

The sample size was 957 veterans.¹⁵The POQ-VA is reverse scored, meaning lower scores indicate improvement. Eighty-seven veterans have completed the program with 20 participants completing the 3-month outcome measures, 31 participants completing 6-month outcome measures, and 17 participants completing 12-month outcome measures.

The pain score decreased close to 1 point at 12 months. The mobility gains were maintained at 12 months. The ADL did not improve much after 1 year (Figure 1).

It is important to consider that some participants already had mobility issues and used an assistive device for ambulation. The addition of an occupational therapist to the program may help patients in their improvement of ADLs.

In the other POQ-VA subscales, vitality improved somewhat.

The negative affect and fear improved after 12 months. It is noteworthy that the number of veterans who were taking opioids also decreased from 25 to 15 immediately after completing the program (Figure 2).

There also was a significant decrease in health care visits (VA and non-VA providers) related to pain (Figure 3).

Limitations

Only a small sample size of veterans with chronic pain participated in the functional restoration pain program. Long-term follow-up of participants who successfully completed the program also is desired.

Conclusion

Veterans experiencing complex chronic noncancer pain present a challenge for the VA health care system. Successful management of this requires cooperation among different disciplines and fostering a multimodal and interdisciplinary approach. Functional restoration pain programs have existed for a while and have shown clear evidence of their superiority over monotherapies for patients with chronic noncancer pain.

This functional restoration pain program incorporated various evidence-based medical, rehabilitative, psychological interventions with mind body medicine, mindfulness and integrative pain modalities. The authors continually meet and assess the success of the program. Although the initial outcome measures are encouraging, increased veteran participation in answering their post program completion surveys is desired. The goal is to improve veterans’ self-management of their chronic pain, leading to reductions in pain symptoms, medication, and health care provider use, as well as improve veterans’ function and overall QOL.

References

1. International Association for the Study of Pain. IASP taxonomy. https://www.iasp-pain.org/Taxonomy#Pain. Updated May 22, 2012. Accessed August 31, 2017.

2. Nahin RL. Severe pain in veterans: the effect of age and sex, and comparisons with the general population. J Pain. 2017;18(3):247-254.

5. Hogan ME, Taddio A, Katz J, Shah V, Krahn M. Health utilities in people with chronic pain using a population level survey and linked health care administrative data. Pain. 2017;158(3):408-416.

7. Gallagher RM. Advancing the pain agenda in the veteran population. Anesthesiol Clin. 2016;34(2):357-378.

10. U.S. Department of Veterans Affairs. Transforming VA pain care. https://www.va.gov/painmanagement/Updated August 17, 2017. Accessed August 31, 2017.

11. American Pain Society. Interdisciplinary pain management. http://americanpainsociety.org/uploads/about/position-statements/interdisciplinary-white -paper.pdf. Accessed August 31, 2017.

12. Stanos S. Focused review of interdisciplinary pain rehabilitation programs for chronic pain management. Curr Pain Headache Rep. 2012;16(2):147-152.

13. Cosio D, Lin EH. (538) Efficacy of an outpatient, multidisciplinary VA pain management clinic: findings from a one-year outcome study. Pain. 2014;15(4):S110.

14. Cosio D, Lin EH. Effects of a pain education program in complementary and alternative medicine treatment utilization at a VA medical center. Complement Ther Med. 2015;23(3):413-422.

15. Clark ME, Gironda RJ, Young RW. Development and validation of the pain outcomes questionnaire-VA. J Rehabil Res Dev. 2003;40(5)-381-395.

Outcomes Associated With a Multidisciplinary Pain Oversight Committee to Facilitate Appropriate Management of Chronic Opioid Therapy

Restoring Function in Veterans With Complex Chronic Pain

References

Program Effectiveness

Limitations

Conclusion

Pages

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