Thirteen research projects totaling approximately $21.7 million over 5 years will explore nondrug approaches to managing pain and related health conditions such as post-traumatic stress disorder (PTSD), drug abuse, and sleep issues. The effort seeks to enhance options for the management of pain and associated problems in U.S. military personnel, veterans, and their families.
The National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM) and National Institute on Drug Abuse (NIDA) and the U.S. Department of Veterans Affairs (VA) Health Services Research and Development Division provided funding for this initiative. The research projects are located at academic institutions and VA medical centers across the United States.
"Pain is the most common reason Americans turn to complementary and integrative health practices," said Josephine P. Briggs, M.D., Director of NCCAM. "The need for nondrug treatment options is a significant and urgent public health imperative. 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 2011 Institute of Medicine (IOM) report states that nearly 100 million American adults suffer from chronic pain at a cost of $635 billion per year and notes a need for a cultural transformation to change this problem. 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.
"Unless the 'cultural transformation' called for by the IOM begins in earnest, our nation faces additional crises in the future. Many service members and veterans with pain also have comorbid conditions such as posttraumatic stress syndrome or traumatic brain injury," a commentary in the journal said. "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. Without more effective and less costly approaches to pain management, the estimated costs of care and disability to the country will approach $5 trillion."
One co-author of the commentary is Eric B. Schoomaker, M.D., Ph.D., a retired U.S. Army lieutenant general who is a scholar-in-residence and Distinguished Professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and is a member of NCCAM's Advisory Council. The other is Wayne B. Jonas, M.D., a retired U.S. Army lieutenant colonel who is president of the Samueli Institute, a nonprofit organization in Alexandria, Virginia, with a mission that includes applying academic rigor to research on healing, well-being, and resilience; and translating evidence into action for the U.S. military and large-scale health systems.
Pain is not the only issue. According to the JAMA Internal Medicine report, 15 percent of U.S. military post-deployment use opioids, compared to 4 percent of the general public. Drugs such as opioids that are available to manage chronic pain are not consistently effective, have disabling side effects, may exacerbate pain conditions in some patients, and are often misused. According to NIDA, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for nonmedical reasons at least once in their lifetimes.
"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, M.D., Director of NIDA. "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."
The thirteen new studies under this initiative are:
- 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 a morning bright light treatment to reduce and help manage chronic low-back pain and improve post-traumatic stress disorder (PTSD) symptoms, mood, and sleep in veterans. (NCCAM-funded).
- Eric Elbogen, Ph.D., University of North Carolina, Chapel Hill. Dr. 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).
- Mark Jensen, Ph.D., University of Washington, Seattle. The project will compare the efficacy of self-hypnosis and mindfulness meditation to education for reducing pain and improving quality of life in veterans. The project will also test biological, psychological, and social factors such as brain activity, expectation, and physician-patient relationships that could explain the impact of the effects of the interventions. (NCCAM-funded).
- Robert Kerns, Ph.D., Yale University, West Haven, Connecticut. Dr. Kerns has a joint appointment at the VA Connecticut Healthcare System. This study will use novel approaches to gather data from electronic health records to examine the assessment and treatment of veterans with chronic pain, particularly in regard to use of complementary/integrative health approaches. The methods developed will facilitate assessment of an approach to pain management called a stepped care model, which starts with lower intensity, less costly, and less invasive treatments and, if needed, steps up to more intensive or complex treatments. (VA- and NCCAM-funded).
- Mary Jo Larson, Ph.D., Brandeis University, Waltham, Massachusetts. The project will expand data collection and conduct additional analyses of data from the Substance Use and Psychological Injury Combat Study (SUPIC). This can determine the prevalence of post deployment chronic pain for active duty and reserve component Army members, how complementary/nonpharmacologic health approaches are used to manage chronic pain, and outcomes associated with use of complementary/nonpharmacologic approaches. (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).
- Shari Miller, Ph.D., Research Triangle Institute, Research Triangle Park, North Carolina. The pilot project will test the acceptability and practicality of an interactive mindfulness meditation training program--using Web-based platforms and mobile apps--with active duty soldiers being treated for chronic pain. (NCCAM-funded).
- Melissa Polusny, Ph.D., University of Minnesota, Minneapolis. Dr. Polusny has a joint appointment at the Minneapolis VA Health Care System. The study will use medical health records and survey data to develop a model for understanding chronic pain outcomes, use of complementary health approaches and other nonpharmacologic approaches, and use of opioids for chronic pain as well as gain a deeper understanding of veterans' preferences and attitudes towards pain management. (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).
- Stephanie Taylor, Ph.D., Sepulveda Research Corporation, North Hills, California. Dr. Taylor has a joint appointment at the VA Greater Los Angeles Healthcare System. This research will study the extent and cost-effectiveness of complementary and alternative medicine use among veterans being treated at the VA for musculoskeletal disorder-related pain and related conditions. (VA-funded).
- Kevin Vowles, Ph.D., University of New Mexico, Albuquerque. The aim of this study is to determine the feasibility of integrating two psychotherapeutic interventions: ACT for chronic pain; and Mindfulness Based Relapse Prevention. The mindfulness training teaches patients how to become aware of emotional or physical states that might provoke a relapse for substance use and misuse. (NCCAM-funded).
This work is supported by the following grants: DA038971, AT008347, AT008399, AT008427, AT008336, AT008448, AT008404, AT008422, AT008423, AT008387, AT008349, HX001704, AT008398.