ESCAPE Study Evaluates Stepped Care For Chronic Pain in Veterans

Matthew J. Bair, MD, MS Research Service, Veterans Affairs Health Services Research and Development, Center for Health Information and Communication Richard L. Roudebush Veterans Affairs Medical Center, Department of Medicine, Indiana University School of Medicine, Health Services Research, Regenstrief Institute, Inc, Indianapolis, IndianaMedicalResearch.com Interview with:
Matthew J. Bair, MD, MS
Research Service, Veterans Affairs Health Services Research and Development, Center for Health Information and Communication
Richard L. Roudebush Veterans Affairs Medical Center,
Department of Medicine, Indiana University School of Medicine, Health Services Research, Regenstrief Institute, Inc, Indianapolis, Indiana

MedicalResearch.com: What is the background for this study?

Dr. Bair: Despite the prevalence and functional, psychological, and economic impact of chronic pain, there have been few intervention studies to treat chronic pain in Veterans.

MedicalResearch.com: What are the main findings?

Dr. Bair: A stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in Veterans with chronic musculoskeletal pain.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Bair: Our study adds to the literature about multi-modal approaches that combine pharmacological and non-pharmacological treatments that may be applied in non-specialty settings.  Study findings have implications for the patient-centered medical home (PCMH) environment especially an emphasis on team-based care. The ESCAPE study demonstrates a potential model of sequencing pain treatments involving analgesics, self-management strategies, and cognitive behavioral therapy. Furthermore, ESCAPE involved a telephone-based intervention delivered by nurse care managers that may be applied across multiple geographically dispersed clinical settings.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Bair: We need to continue to develop and test interventions that combine pharmacologic and non-pharmacologic treatments that address some of the barriers to effective pain management that can be practicably applied in primary care settings.

Citation:

Bair MJ, Ang D, Wu J, et al. Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts: A Randomized Clinical Trial. JAMA Intern Med. Published online March 09, 2015. doi:10.1001/jamainternmed.2015.97.

MedicalResearch.com Interview with: Matthew J. Bair, MD, MS (2015). ESCAPE Study Evaluates Stepped Care For Chronic Pain in Veterans