Structured Approach to Chronic Pain Management Is Effective in Veterans

The reported prevalence of chronic pain in U.S. veterans returning from Iraq and Afghanistan is as high as 50%, with substantial functional effects. The effectiveness of current approaches is modest at best. In this clinical trial, researchers recruited 241 veterans at a single Veterans Affairs medical center who reported ≥3 months of disabling pain in the spine or extremities. Patients were excluded for severe medical and mental illnesses or for substance abuse.

Participants were randomized to a stepped-care intervention, delivered by nurse care managers and supervised by a psychologist, or to usual care. The stepped-care approach employed evidence-based, protocol-driven optimization of analgesic therapy (using 8 classes of analgesics — ace…