Mindfulness-Based Interdisciplinary Pain Management Program for Complex Polymorbid Pain in Veterans: A Randomized Clinical Trial.

OBJECTIVE: To evaluate the effects of interdisciplinary pain management on pain-related disability and opioid reduction in polymorbid pain patients with two or more comorbid psychiatric conditions.

DESIGN: Two-arm randomized clinical trial testing a three-week intervention with assessments at pre-treatment, post-treatment, 6-month and 12-month follow-up.

SETTING: Department of Veterans Affairs medical facility.

PARTICIPANTS: 103 military veterans with moderate (or worse) levels of pain-related disability, depression, anxiety, and/or PTSD randomly assigned to usual care (n=53) and interdisciplinary pain management (n=50). All participants reported recent persistent opioid use. Trial participants had high levels of comorbid medical and mental health conditions.

INTERVENTIONS: Experimental arm - a three-week, interdisciplinary pain management program guided by a structured manual; Comparison arm - usual care in a large VA medical facility.

MAIN OUTCOME MEASURES: Oswestry Disability Index (pain disability); Timeline Followback Interview and Medication Event Monitoring System (opioid use). Analysis used generalized linear mixed model with all posttreatment observations (posttreatment, 6-month follow-up, 12-month follow-up) entered simultaneously to create a single posttreatment effect.

RESULTS: Veterans with polymorbid pain randomized to the interdisciplinary pain program reported significantly greater decreases in pain-related disability compared to veterans randomized to treatment as usual (TAU) at posttreatment, 6-month and 12-month follow-up. Aggregated mean pain disability scores (i.e., a summary effect of all posttreatment observations) for the interdisciplinary pain program were -9.1 (95% CI: -14.4, -3.7, P = .001) points lower than TAU. There was no difference between groups in the proportion of participants who resumed opioid use during trial participation (32% in both arms).

CONCLUSION: These findings offer the first evidence of short- and long-term interdisciplinary pain management efficacy in polymorbid pain patients, but more work is needed to examine how to effectively decrease opioid use in this population.