Newswise, June 3, 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?”
About the American Pain Society
Based in Chicago, the American Pain Society (APS) is a
multidisciplinary community that brings together a diverse group of scientists,
clinicians and other professionals to increase the knowledge of pain and
transform public policy and clinical practice to reduce pain-related
suffering. APS is the professional home for investigators involved in all
aspects of pain research including basic, translational, clinical and health
services research to obtain the support and inspiration they need to flourish
professionally. APS strongly advocates expansion of highquality pain
research to help advance science to achieve effective and responsible pain
relief. For more information on APS, visit www.americanpainsociety.org.
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