Federal research seeks alternatives to addictive opioids for veterans in pain

By Emily Wax-Thibodeaux September 25

The National Institutes of Health and the Department of Veterans Affairs this week announced that they will launch a five-year, $21.7 million initiative to study the effectiveness of alternative therapies to opioids through a series of 13 research projects.
Nearly half of all troops returning home from Afghanistan and Iraq are suffering from chronic pain, more than double the civilian population, according to the Journal of the American Medical Association. Many of those veterans have been prescribed opioids.
The drugs often have disabling side effects, and some studies show they are often addictive and may exacerbate pain conditions in some patients.

(Paula Bronstein/Getty)

The joint research program includes studies on the use of morning light to treat lower-back pain and post-traumatic stress disorder, and the use of chiropractors, self-hypnosis and meditation to reduce pain, said Josephine P. Briggs, director of the National Center of Complementary and Alternative Medicine at NIH.
Funding for the initiative comes from the NCCAM, the National Institute on Drug Abuse and the VA’s Health Services Research and Development Division. The research projects will be done at academic institutions and VA medical centers across the United States.
“This is a very urgent issue for the soldiers returning home – the magnitude of the problem is huge,” Briggs said. “We believe this research will provide much-needed
information that will help our military and their family members, and ultimately anyone suffering from chronic pain and related conditions.”
Chronic pain disproportionately affects those who have served or are serving in the military. A June 2014 report in JAMA Internal Medicine showed an alarmingly high rate of chronic pain — 44 percent — among members of the U.S. military after combat deployment, compared to 26 percent in the general public.
“Many of them are at risk for a lifetime progression of increasing disability unless the quality, variety, and accessibility of evidenced-based ‘self-management’ skills are improved,” the report said. “Without more effective and less costly approaches to pain management, the estimated costs of care and disability to the country will approach $5 trillion.”
Prescription opioids are one tool for managing pain, but their greater availability and increased prescribing may contribute to their growing misuse, said Nora D. Volkow,
director of the National Institute on Drug Abuse.
“This body of research will add to the growing arsenal of pain management options to give relief while minimizing the potential for abuse, especially for those bravely serving
our nation in the armed forces,” Volkow said.
The new studies under the joint initiative include:
* Jeffrey Borckardt, Ph.D., Medical University of South Carolina, Charleston. The project will evaluate the efficacy of combining transcranial direct current stimulation (constant low current delivered to specific brain areas via small electrodes placed on the scalp) with cognitive behavioral therapy (a type of psychotherapy that helps patients understand thoughts and feelings that influence behaviors) for the treatment of pain, opioid use, and related health issues. (NIDA-funded).
* Helen Burgess, Ph.D., Rush University Medical Center, Chicago. The pilot study will use and test the feasibility of the use of a bright morning light treatment to reduce and
help manage chronic low-back pain and improve post-traumatic stress disorder (PTSD) symptoms, mood, and sleep in veterans to the use of chiropractors and self-hypnosis and mindfulness meditation to reduce pain.
* Eric Elbogen, Ph.D., University of North Carolina, Chapel Hill. Elbogen has a joint appointment at the Durham VA Medical Center. This project will test the feasibility,
acceptability, utilization, and effectiveness of using mobile devices that display real-time brain activity that veterans with PTSD and traumatic brain injury can use to
induce relaxation and reduce pain symptoms. (NCCAM-funded).
* Christine Goertz, D.C., Ph.D., Palmer College of Chiropractic, Davenport, Iowa. The project will develop an innovative and collaborative treatment model between
chiropractors, primary care providers, and mental health providers for veterans with spine pain and related mental health conditions. (NCCAM-funded).
*Donald McGeary, Ph.D., University of Texas Health Science Center, San Antonio. This project will evaluate the effectiveness of an integrated program to improve physical
function/reduce disability and decrease rates of chronic opioid use of combat-injured veterans with multiple traumatic injuries. The approach integrates relaxation, biofeedback, guided exercise, imagery, mindfulness meditation, cognitive-behavioral therapies, and weekly team meetings with physical therapy and medical care. (NCCAM-funded).
* Barbara Rakel, Ph.D., University of Iowa, Iowa City. The pilot project’s aim is to reduce post-surgical pain and opioid use among veterans at risk due to pre-operative
stress. The study will test feasibility and explore outcomes of an innovative delivery format of Acceptance and Commitment Therapy (ACT), a type of psychotherapy that is
based on acceptance and awareness of difficult emotions, as an addition to usual care. (NCCAM-funded).

Emily Wax-Thibodeaux is a National staff writer who covers veterans, veterans' affairs and the culture of government. She's an award-winning former foreign correspondent who covered Africa and India for nearly a decade. She also covered immigration, crime and education for the Metro staff.