Veterans Adopt Alternative Treatments for Chronic Pain After Education


Las Vegas—Veterans with chronic pain accessed more complementary and alternative treatments at a Veterans Affairs (VA) medical center after attending a “pain education school,” and those participating in a functional medicine clinic reported reductions in perceived stress and musculoskeletal pain, according to results of two studies presented at the PAINWeek 2017 meeting.

The lead investigator of both studies, David Cosio, PhD, a health psychologist at the Jesse Brown VA Medical Center, in Chicago, told Pain Medicine News that while the VA system requires its facilities to offer at least two alternatives to traditional medical approaches to chronic pain, the pain treatment center serves a tristate area and offers 23 complementary and alternative medicine (CAM) options.

Dr. Cosio and his co-investigator Erica Lin, PharmD, a clinical pharmacy specialist also at the Jesse Brown VA Medical Center, conducted an analysis of data from their previous study of participation in an innovative pain education initiative to determine what “take-away” lessons might be reflected in the behavior of the participants after completing the coursework.

“We were hoping to find that after they went through pain education school, that they would use more active treatment as opposed to the passive and transitional treatments—and that’s exactly what we found,” Dr. Cosio said.

Drs. Cosio and Lin distinguish between CAM treatments that are active, such as movement programs, music/art therapy and mindfulness training; passive, such as acupuncture and massage therapy; and transitional, such as chiropractic care and osteopathic manipulation.

Upon entry into the pain education program, 44% of subjects (n=45) had not used any type of CAM. In the remaining 56%, CAM was used in different combinations, with 30% active, 41% passive and 36% transitional. After completing the program, 86% of subjects were accessing CAM treatments, and many more had entered into active modalities (24%) than passive (12%) or transitional (14%).

“As we educate people about the existence of these treatments, they are going to use them,” Dr. Cosio said. “I think that part of the problem [is] that patients may not be aware of the complementary and alterative medicine options that are available.”

Improving Health While Relieving Pain

The functional medicine pilot program for chronic pain at Jesse Brown VA Medical Center was implemented by Dr. Cosio with David Schaefer, DO, MPH, and dietitian Shari Pollack, MPH, RDN. The trio collaborated on the assessment of the program that Dr. Cosio reported at the PAINWeek meeting.

The researchers posited that functional medicine addresses many of the preventable factors that can underlie chronic illness. “Most chronic diseases are preventable and reversible if a comprehensive, individualized approach that addresses genetics, diet, stress, physical activity and sleep is implemented through integrated function medicine teams and based on empirical research,” they wrote.

With previous research finding that the burden of chronic illness can amplify the perception of pain severity and associated impaired functioning, Dr. Cosio and his colleagues undertook the pilot program to determine whether improving wellness behaviors could also relieve pain symptoms. The program focused on diet, exercise, stress management and sleep hygiene. Diet was the most complex component of the program, Dr. Cosio said, with an emphasis on anti-inflammatory properties from reducing refined sugar and processed foods and avoiding such potential sensitivity triggers as dairy products and gluten.

The program involved 51 veterans 18 to 75 years of age, with mixed, idiopathic chronic pain conditions. The intervention was delivered over three weeks, with four group sessions lasting approximately 60 to 75 minutes, and individual follow-up sessions as needed. Pre- and post-intervention assessments included the Medical Symptoms Questionnaire, the Perceived Stress Scale and the Insomnia Severity Index. The efficacy measures included reduction in pain intensity, medical symptoms, perceived stress and insomnia, as well as reduced weight, waist/hip circumference and increased walking speed.

“After three weeks, those who completed the program (53%) did witness change in their weight, compared to those who did not finish the program,” Dr. Cosio said. “The medical symptoms that were related to pain tended to have significant reduction.”

Because of multiple assessments on relatively few patients, the investigators applied a Bonferroni correction in their analysis. After that correction, they found a significant reduction in perceived stress and joint/muscle symptoms of pain, as well as in arthritis.

“So, that’s pretty amazing,” Dr. Cosio said. “This is probably one of the first studies to show that doing an ‘anti-inflammatory’ diet, we should expect some changes in the lowering of their pain.”

Asked about the lack of data on patients’ adherence to the diet, or on the extent that other components of the program could have contributed to the results, Dr. Cosio said, “Maybe we’re getting too excited too quickly, but it is something new and something easy that providers can incorporate into their practice. So, we’re excited to share that with people.”

—Kenneth Bender
Pain Medicine News

Veterans Adopt Alternative Treatments for Chronic Pain After Education