Magazine article Clinical Psychiatry News

Stepped-Care Beats Usual Care for Chronic Pain

Magazine article Clinical Psychiatry News

Stepped-Care Beats Usual Care for Chronic Pain

Article excerpt

FROM JAMA INTERNAL MEDICINE

A stepped-care intervention balancing pain relief, self-management strategies, and cognitive-behavioral therapy achieves significant improvements in chronic pain, compared with usual care by pharmacological and nonpharmacological means, according to a study.

A randomized, controlled trial of 241 veterans with chronic and disabling musculoskeletal pain found that veterans of the Iraq and Afghanistan conflicts treated with the stepped intervention experienced a more than twofold greater reduction in Roland Morris Disability Scale and Graded Chronic Pain Scale severity scores, compared to those in the control arm (-3.7 vs. -1.7, P = .002, and-11.1 vs. -4.5, P = .001) at 9 months after randomization.

The intervention involved 12 weeks of optimized analgesic therapy combined with the teaching of pain self-management strategies, followed by an additional 12 weeks including adapted cognitive-behavioral therapy (JAMA Intern. Med. 2015 March 9 [doi:10.1001 / jamainternmed.2015.97]).

"The patients spoke about their evolving understanding of their pain experience during the trial and how this new understanding helped them manage their pain more effectively," wrote Dr. Matthew J. …

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