Evaluation of Stepped Care for Chronic Pain in Iraq/Afghanistan Veterans (ESCAPE) (ESCAPE)
The purpose of this study is to determine if a stepped-care intervention makes pain symptoms better and reduces activity limitations because of pain. Our two primary hypotheses are that in OIF/OEF veterans with chronic pain:
- Stepped care is more effective than usual care in reducing pain-related disability
- Stepped care is more effective than usual care in reducing psychological distress
|Low Back Pain Pain Pain, Intractable||Behavioral: Cognitive behavioral therapy Behavioral: Pain self-management program Drug: Co-Analgesic Therapy Drug: Opioid Analgesics|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Evaluation of Stepped Care for Chronic Pain in Iraqi/Afghanistan Veterans|
- Roland-Morris Disability Questionnaire [ Time Frame: at baseline and 9 months ]This is a 24-item pain specific disability questionnaire consisting of 24 questions which are related specifically to physical functions that are likely to be affected by back pain. The questionnaire is scored by adding up the number of items checked by the subject (0-24 range). Greater levels of disability are reflected by higher numbers.
- Brief Pain Inventory (Interference) [ Time Frame: Baseline and 9 months ]This is an 7-item measure that provides scores for pain-related functional impairment. The seven (7) pain interference items are rated on a simple numeric rating scale from 0-10. On the scale 0 represents "no interference" and 10 is "completely interferes". The pain interference score is achieved by taking the total of all seven (7) scores and dividing it by the number of items (7).
- Psychological Distress (PHQ-9, MCS Score of SF-12, PRIME-MD Anxiety, PTSD Checklist (PCL-17)) [ Time Frame: at baseline, 3, 6, and 9 months ]
- Clinical Response (Global Rating of Change) [ Time Frame: at baseline, 3, 6, and 9 months ]
- Work Function (Work and Health Interview) [ Time Frame: at baseline, 3, 6, and 9 months ]
- Generic HRQL (SF-12) [ Time Frame: at baseline, 3, 6, and 9 months ]
- Pain Self-efficacy (Arthritis Self-efficacy Scale) [ Time Frame: at baseline, 3, 6, and 9 months ]
|Study Start Date:||December 2007|
|Study Completion Date:||September 2012|
|Primary Completion Date:||May 2012 (Final data collection date for primary outcome measure)|
No Intervention: Usual Care
Study subjects randomized to this arm would receive usual care from their provider(s). No study intervention is undertaken on subjects in this arm. Participants in Usual Care would complete the same four outcome assessments (surveys) throughout the course of the study that members of the intervention complete.
Experimental: Stepped Care
Study subjects randomized to this arm would receive stepped care for their pain. Stepped care involves FDA-approved analgesic therapy, a 12-week pain self-management program, and if pain does not improve, a 12-week cognitive behavioral therapy program.
Behavioral: Cognitive behavioral therapy
Cognitive behavioral therapy is delivered by phone by a nurse care-manager 6 times over a 12-week period. Sessions last approximately 45 minutes and occur at weeks 14, 16, 18, 20, 22, and 24 of the study.
Other Name: Often referred to as "CBT."Behavioral: Pain self-management program
The pain self-management program is delivered by a nurse care-manager during a 12-week period. Sessions are each 45 minutes long and phone-based. They occur at baseline, week 1, week 3, week 6, week 9, and week 12.Drug: Co-Analgesic Therapy
Drug: Opioid Analgesics
Amitriptyline, start at 10-25, titrate to 100 mg Nortriptyline, start at 10-25, titrate to 100 mg
Gabapentin, titrate up to 900-1200 tid venlafaxine, carbemazepine, duloxetine, and/or pregabalin
Cyclobenzaprine, titrate to 10 mg TID fluoxetine, sertraline, citalopram
Tramadol 50 mg BID or TID and titrate to 100 mg QID Acetaminophen/codeine (300mg/30mg). Take 1 or 2 tablets qid prn pain Acetaminophen/hydrocodone (500mg/5mg). Take 1 or 2 tablets qid prn pain Acetaminophen/oxycodone (500mg/5mg). Take 1 or 2 tablets qid prn pain Morphine SR (30mg). Start at 30 mg twice a day (titrate up to 240mg/day if needed) Methadone (5-10mg). Start at 5mg bid; titrate 10mg tid (max 20mg tid)
Please refer to this study by its ClinicalTrials.gov identifier: NCT00386243
|United States, Indiana|
|Richard Roudebush VA Medical Center, Indianapolis|
|Indianapolis, Indiana, United States, 46202-2884|
|Principal Investigator:||Matthew J. Bair, MD MS||Richard Roudebush VA Medical Center|