Chronic pain study suggests meds management better than therapy

A study on chronic lower back pain among veterans who have been taking opioids long term found that targeted management of medication resulted in better outcomes when compared with cognitive behavioral therapy, but that the results did not give a clear indication of which approach is better.

Researchers who published their findings in the Journal of the American Medical Association network on Thursday concluded that the results “indicate that a collaborative care medication optimization approach has a statistically significant but clinically modest benefit when compared with CBT for 12 months.”

With 261 veterans involved in the study, researchers reviewed cases and treatment plans with physician and pharmacist investigators during weekly meetings for 131 of them, adjusting pain medications as appropriate. The other 130 veterans received eight, 45-minute cognitive behavioral therapy sessions over nine months, focusing on “barrier identification, skill learning, and practice” and “reflection, practice assignments, and goal setting” in managing their pain.

The study measured “brief pain inventory” scores among participants at six and 12 months, finding that pain improvements were “significantly greater” in the medicine group at 12 months. Scores on the BPI range from 0 to 10, with higher scores representing greater pain impact. Also measured were secondary outcomes, including pain-related disability, pain catastrophizing, self-reported substance misuse, health-related quality of life, depression and anxiety.

Researchers conclude that the outcomes between the two approaches, which found managed pharmaceuticals as a better approach, “may not be clinically meaningful or generalize to nonveteran populations” and that this “finding suggests that both pharmacological and behavioral approaches are reasonable options for chronic pain.”

The study was conducted by researchers from eight institutions, including the Indiana University School of Medicine in Indianapolis, the Veterans Affairs Health Services Research & Development Center for Health Information and Communication, and the Roudebush Veterans Administration Medical Center in Indianapolis.