Self-management programs help veterans to better manage and cope with pain symptoms

May 22 2017

Self-management programs are teaching veterans with chronic pain to become more active, manage symptoms, reduce stigma and frustration, and minimize depression and other mood disorders, according to a VA researcher speaking today at the American Pain Society Annual Scientific Conference, www.americanpainsociety.org.

Robert Kerns, Ph.D., professor of psychiatry, neurology and psychology at Yale University, spent 38 years practicing in VA healthcare, most recently the VA Connecticut Healthcare System. He reported in a plenary session presentation that the VA's applications of cognitive-behavioral therapies (CBT) and other approaches are helping veterans better manage their pain through standardized pain assessments, alternative therapies, patient education and self-care. The VA also is succeeding in reducing drug use.

"The proportion of VA patients receiving high doses of opioids has decreased significantly in the last four years concurrent with greater use of non-drug alternative pain therapies," said Kerns. "Several trials have shown that when patients are engaged in their own care they have less pain, less depression, and are more physically active."

The VA estimated in one study that 44 percent of soldiers in an Army infantry brigade reported chronic pain three months after returning from tours of duty in Afghanistan and Iraq – double the rate among civilians. Spinal disorders have increased by 300 percent in the last 50 years and now rank as the number-one cause of disability in the United States and in the military.

Kerns added the National Pain Strategy's strong advocacy of self-care will provide more educational resources and greater incentives to help physicians empower their patients to become more proficient at managing and coping with their pain.

The National Pain Strategy, released last year by the U.S. Department of Health and Human Services, places strong emphasis on self-management and patient education as critical pathways for improving treatment of chronic pain. Kerns added that the VA is funding several research projects to evaluate the efficacy self-management interventions for persistent pain, including novel approaches that employ advanced communication technologies.

"Specifically for pain management, self-care programs involve gaining knowledge about pain and building skills and confidence to prevent, cope with and reduce pain," said Kerns. The overall objective is to promote adoption of an effective approach to pain self-management, similar to models for treating chronic illnesses."

Kerns added that in re-conceptualizing pain as a chronic disease, it is imperative to understand that pain management is not a cure, realistic therapy goals must be established, and the overall focus should be placed on achieving optimal functioning, well-being and quality of life.

Elements for successful self-management of chronic pain therefore include:

• Empowering persons with pain through reassurance, encouragement and education
• Conservative use of analgesics and adjuvant medications
• Promotion of regular exercise and healthy and active lifestyles
• Development of adaptive strategies for managing pain.

Kerns described the role communication technology is playing in helping the VA to promote access and engagement in pain self-management. "Attendance at sessions is the key variable governing treatment outcomes," said Kerns. "Technology is making it easier for more vets to participate in cognitive-behavioral therapy through real-time video conferencing, apps for smartphones, phone-based interactive voice response and web-based CBT interventions for pain and co-prevalent mental and behavioral health problems."

Outcomes for the VA program were published in JAMA Internal Medicine this year and showed that patients accessing CBT remotely did just as well as patients receiving in-person therapy. Patient surveys provided additional verifications. On a seven to 10 scale, the average response of 22 patients was 7.75 in answering the question: "How confident are you that this treatment successfully helped you with your pain?"