Nonpharmacologic Therapy

ISSUE: NOVEMBER 2014 | VOLUME: 12(11)

Massive Research Project Targets Chronic Pain in the Military

Spanning five years, costing almost $22 million and spread across 13 separate research trials nationwide, several federal agencies are tackling head-on the mounting problem of how to treat chronic pain in the U.S. military without exacerbating the country’s opioid abuse problem.

The new research program, spearheaded by the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM), the National Institute on Drug Abuse (NIDA) and the U.S. Department of Veterans Affairs (VA) Health Services Research and Development Division, will look at non-drug approaches for treating chronic pain and some of the conditions that go hand-in-hand with it, such as post-traumatic stress disorder (PTSD), drug abuse and sleep problems. Modalities to be studied will include, but are not limited to psychotherapy, bright light therapy and self-hypnosis. (See the table for a full list of the studies and lead investigators.)

Table. Chronic Pain Studies Focusing on the U.S. Military Treatment Modality Conditions Lead Investigator (Institution) Transcranial direct current stimulation and CBT combination therapy Chronic pain, opioid use, related health issues Jeffrey Borckardt, PhD (Medical University of South Carolina) Morning bright light exposure Chronic low back pain, PTSD, mood, sleep Helen Burgess, PhD (Rush University Medical Center) Use of mobile devices to display real-time brain activity to induce relaxation and pain relief PTSD, TBI Eric Elbogen, PhD (University of North Carolina) Collaborative treatment model (chiropractic, primary care, mental health) Spine pain, related mental health conditions Christine Goertz, DC, PhD (Palmer College of Chiropractic) Self-hypnosis, mindfulness meditation, education Chronic pain, poor QoL Mark Jensen, PhD (University of Washington, Seattle) Novel approaches to EHRs Chronic pain Robert Kerns, PhD (Yale University) Complementary/​nonpharmacologic approaches Chronic pain Mary Jo Larson, PhD (Brandeis University) Biofeedback, guided exercise, imagery, mindfulness meditation, CBT Opioid use in veterans with multiple traumatic injuries Donald McGeary, PhD (University of Texas Health Science Center) Interactive mindfulness meditation Chronic pain Shari Miller, PhD (Research Triangle Institute) Complementary/​nonpharmacologic approaches Chronic Pain Melissa Polusny, PhD (University of Minnesota) ACT Reduce postsurgical pain, opioid use due to preoperative stress Barbara Rakel, PhD (University of Iowa) Cost-effectiveness of complementary and alternative medicine Musculoskeletal disorder–related pain and related conditions Stephanie Taylor, PhD (Sepulveda Research Corporation) CBT, mindfulness-based relapse prevention Chronic pain–related substance abuse and misuse Kevin Vowles, PhD (University of New Mexico) ACT, acceptance and commitment therapy; CBT, cognitive-behavioral therapy; EHRs, electronic health records; PTSD, post-traumatic stress disorder; QoL, quality of life; TBI, traumatic brain injury

The multicenter research effort, involving VA medical centers and academic institutions, will not only focus on active military and U.S. veterans, but will look at the effects on their families as well.
According to NCCAM director Josephine Briggs, MD, more Americans turn to complementary and alternative therapies for pain relief than for any other condition. That fact, and the need to stem the increasing problem of prescription painkiller abuse among military personnel, has led to the large-scale research effort, she said.
“The need for non-drug treatment options is a significant and urgent public health imperative,” Dr. Briggs said in a statement. “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.”
A recent large-scale study (N=2,597) showed that chronic pain among U.S. military following deployment was reported by 44% of study subjects, compared with 26% in the general population, and opioid use was seen in 15% versus 4%, respectively. Of individuals reporting chronic pain in the study, 65.6% described it as constant, and 51.2% stated that their pain was moderate or severe. Estimated costs related to chronic pain and its treatment in military personnel are close to $5 trillion (JAMA Intern Med 2014;174:1402-1403).
“Prescription opioids are important tools for managing pain, but their greater availability and increased prescribing may contribute to their growing misuse,” said Nora D. Volkow, MD, director of NIDA, in a statement. “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.”