Empower Veterans Program (EVP): a chronic pain management program demonstrates positive outcomes among veterans

Author: Jolie N Haun1,2, Christopher A Fowler3,4, Hari H Venkatachalam1, Michael S Saenger5,6, Amy C Alman1,2, Bridget M Smith7, Tali Schneider1, Rachel Benzinger1, Kevin Stroupe7, Dustin D French7,8,9
1 Research and Development Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, USA.
2 Division of Epidemiology, Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.
3 Research and Development Service, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, USA. Christopher.Fowler3@va.gov.
4 Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL, 33613, USA. Christopher.Fowler3@va.gov.
5 Anesthesia Service Line, Atlanta Veterans Administration Health Care System, 1670 Clairmont Rd, Decatur, GA, 30033, USA.
6 Division of Internal Medicine, School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA.
7 Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Ave, Hines, IL, 60141, USA.
8 Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair St. Suite 2000, Chicago, IL, 60611, USA.
9 Departments of Ophthalmology and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave. Suite 440, Chicago, IL, 60611, USA.
Conference/Journal: BMC Health Serv Res
Date published: 2023 May 3
Other: Volume ID: 23 , Issue ID: 1 , Pages: 431 , Special Notes: doi: 10.1186/s12913-023-09327-5. , Word Count: 320

Chronic pain is a highly prevalent health condition among veterans. Traditional pharmacological interventions present unique challenges for chronic pain management including prescription opioid addiction and overdose. In alignment with the 2016 Comprehensive Addiction and Recovery Act and VA's Stepped Care Model to meet veterans' pain management needs, the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) funded an enterprise-wide initiative to implement a Step 3 integrated tele-pain program: Empower Veterans Program (EVP). EVP provides veterans with chronic pain self-care skills using a whole health driven approach to pain management.

The Comprehensive Addiction and Recovery Act prompted the strategic approach to offer non-pharmacological options to meet veterans' pain management needs. EVP, a 10-week interdisciplinary group medical appointment, leverages Acceptance and Commitment Therapy, Mindful Movement, and Whole Health to provide veterans with chronic pain self-care skills. This evaluation was conducted to describe participant characteristics, graduation, and satisfaction rates; and assess pre-post patient-reported outcomes (PRO) associated with EVP participation.

A sample of 639 veterans enrolled in EVP between May, 2015 and December, 2017 provided data to conduct descriptive analyses to assess participant demographics, graduation, and satisfaction rates. PRO data were analyzed using a within-participants pre-post design, and linear mixed-effects models were used to examine pre-post changes in PRO.

Of 639 participants, 444 (69.48%) graduated EVP. Participant median program satisfaction rating was 8.41 (Interquartile Range: 8.20-9.20). Results indicate pre-post EVP improvements (Bonferroni-adjusted p < .003) in the three primary pain outcomes (intensity, interference, catastrophizing), and 12 of 17 secondary outcomes, including physical, psychological, health-related quality of life (HRQoL), acceptance, and mindfulness measures.

Data suggest that EVP has significant positive outcomes in pain, psychological, physical, HRQoL, acceptance, and mindfulness measures for veterans with chronic pain through non-pharmacological means. Future evaluations of intervention dosing effect and long-term effectiveness of the program is needed.

Keywords: Acceptance and Commitment Therapy (ACT); Chronic Pain; Functional Rehabilitation; Mindful Movement; Pain Management; Veterans; Whole health.

PMID: 37138319 DOI: 10.1186/s12913-023-09327-5