Establishing Efficacy of a Functional-restoration-based Pain Management Program

Jan 18, 2017

Those suffering from chronic pain after military trauma often have other chronic symptoms, including posttraumatic stress disorder (PTSD), traumatic brain injury, and depression. Such “polymorbidity” makes all of the conditions more difficult to treat. The multiple trauma symptoms also increase the risk of chronic use of opioid (narcotic) medications. Unfortunately, the opioids frequently prescribed to those with chronic pain can complicate all of the multiple conditions and actually worsen a person’s ability to function.

To help address these problems, Donald McGeary, PhD, of The University of Texas Health Science Center at San Antonio is leading a STRONG STAR-affiliated study evaluating an integrated program to improve physical function/reduce disability and decrease rates of chronic opioid use among veterans with military service-related injuries. The approach integrates relaxation, biofeedback, guided exercise, imagery, mindfulness meditation, cognitive-behavioral therapies, and weekly team meetings with physical therapy and medical care.

To evaluate its effectiveness, this complementary and integrative health approach named FORT-A for “Functional Orthopedic Rehabilitation Treatment” will be compared with the current “treatment as usual.”

Study rationale and objectives

This study arose from an urgent call from the National Institutes of Health for development of pain management programs that do not require medications to provide meaningful approaches to chronic pain management and opioid use.

If successful, Dr. McGeary believes this approach could have a profound impact by offering a non-medication alternative for pain management that decreases opioid use in veterans with pain and trauma symptoms. Elimination of opioid side effects would help them to be productive members of both the military and civilian workforces. It also could reduce their need to visit clinics and emergency rooms, resulting in cost savings for the government and improved access to limited health care resources for other patients.

Dr. McGeary, a clinical health psychologist and assistant professor in the Psychiatry Department, Division of Behavioral Medicine at UT Health San Antonio, says that published research shows that primary care doctors do not like to prescribe opioid medication for pain, but they do it because they do not know of alternatives.

A recent study in the San Antonio Veterans Integrated Service Network (VISN) found that the opioid hydrocodone is the single most commonly prescribed medication in the VISN. And 40 percent of veterans taking opioid medication use it for more than three months. Chronic opioid use among polymorbid veterans has been linked to poor rehabilitation outcomes, abuse of other substances, and death.

McGeary’s team of investigators will work with veterans at the Polytrauma Rehabilitation Center at San Antonio, one of five U.S. Department of Veterans Affairs facilities in the country designed to provide intensive rehabilitative care to veterans and service members who experienced severe injuries, including brain injuries, to more than one organ system. This program is a modification of a previous study McGeary conducted with active-duty Air Force, Army, and Navy personnel, in which half of them stopped using opioid pain medications, even though that program did not talk about the drugs.

An important part of the treatment involves teaching patients to accept and manage the pain, while staying committed to physical therapy and getting their bodies to function at full capacity.