A study of chronic low back pain in veterans taking long-term opioids found that targeted medication management led to better outcomes compared to cognitive behavioral therapy, but the results were unclear which approach was the best.
The researchers who published their findings Thursday in the Journal of the American Medical Association network concluded that the results “indicate that a collaborative care medication optimization approach has a statistically significant but clinically modest advantage over CBT during 12 months”.
With 261 veterans involved in the study, researchers reviewed cases and treatment plans with investigating physicians and pharmacists in weekly meetings for 131 of them, adjusting pain medications as needed. The other 130 veterans received eight 45-minute cognitive-behavioral therapy sessions over nine months, focusing on “identifying barriers, learning skills, and practicing” and “reflection, hands-on drills, and goal setting” in managing their pain.
The study measured ‘Brief Pain Inventory’ scores among participants at six and 12 months, and found pain improvements were ‘significantly greater’ in the medication group at 12 months. Scores on the BPI range from 0 to 10, with higher scores representing greater impact on pain. Secondary outcomes were also measured, including pain-related disability, catastrophic pain, self-reported substance abuse, health-related quality of life, depression, and anxiety.
The researchers conclude that the results between the two approaches, which found managed pharmaceuticals to be a better approach, “may not be clinically meaningful or generalizable to non-veteran populations” and that this “finding suggests that the approaches Pharmacological and behavioral are reasonable options for chronic pain. ”
The study was conducted by researchers at eight institutions, including Indiana University School of Medicine in Indianapolis, Veterans Affairs Health Services Research & Development Center for Health Information and Communication, and Roudebush Veterans Administration Medical Center in Indianapolis.