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

• Type of Material: Article
• Authors: Jolie N Haun, James A. Haley Veterans’ Hospita; Christopher A Fowler, James A. Haley Veterans’ Hospital; Hari H Venkatachalam, James A. Haley Veterans’ Hospital; Michael Saenger, Emory University; Amy C Alman, James A. Haley Veterans’ Hospital; Bridget M Smith, James A. Haley Veterans’ Hospital; Tali Schneider, James A. Haley Veterans’ Hospital; Rachel Benzinger, James A. Haley Veterans’ Hospital; Kevin Stroupe, James A. Haley Veterans’ Hospital; Dustin D French, James A. Haley Veterans’ Hospital
• Language: English
• Date: 2023-12-01
• Publisher: BioMed Central Ltd
• Publication Version: Final Published Version
• Copyright Statement: © 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12913-023-09327-5
• Title of Journal or Parent Work: BMC Health Services Research
• Volume: 23
• Issue: 1
• Start Page: 431
• End Page: 431
• Grant/Funding Information: The Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health (OMAT ID# 16403,16404, 16405, 16489, 16490); and the Pain Management, Opioid Safety and Prescription Drug Monitoring Program Office (PMOP ID# SP8E-PMTIA160) supported the development of this manuscript (Co-PI’s: Haun, Saenger). Early versions of this work (PI: Saenger) were supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Patient-Centered Care and Cultural Transformation (OPCCCT), and the Veterans Integrated Service Network − 7 (VISN 7).
• Keywords: Quality of Life; Whole health; Veterans; Functional Rehabilitation; Acceptance and Commitment Therapy (ACT); Mindful Movement; Acceptance and Commitment Therapy; Pain Management; Chronic Pain; Humans

Abstract

Background: 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. Objectives: 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. Methods: 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. Results: 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. Discussion: 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.