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Clinical Trial
. 2023 Apr;24(2):123-129.
doi: 10.1016/j.pmn.2022.12.007. Epub 2023 Jan 17.

The Role of Psychological Factors in Chronic Pain Treatment Outcomes in the Military

Linda H Eaton  1 , Diane M Flynn  2 , Alana D Steffen  3 , Ardith Z Doorenbos  4
Affiliations
Clinical Trial

The Role of Psychological Factors in Chronic Pain Treatment Outcomes in the Military

Linda H Eaton et al. Pain Manag Nurs. 2023 Apr.

Abstract

Purpose: Chronic pain treatment in the military includes complementary and integrative health (CIH) therapies that may affect psychological factors such as pain catastrophizing, chronic pain acceptance, pain self-efficacy, and patient activation. The unique roles that psychosocial factors play in how CIH approaches reduce pain are not clear. This study examined if a holistic pain management program improved pain outcomes through psychological mediators in service members with chronic pain.

Design: Secondary analysis of a clinical trial.

Methods: Active-duty service members (n = 210) were randomly assigned to a 3-week course of standard rehabilitative care or standard rehabilitative care combined with CIH therapies. Both treatments were followed by a 3-week functional restoration program. Study measures were completed pre- and post-treatment using the Military Health System's Pain Assessment Screening Tool and Outcomes Registry. Mediation analyses tested the indirect effects of the change in psychological factors before functional restoration on the change in pain impact (e.g., pain intensity, pain interference, functional status) after functional restoration.

Results: All psychological factors except for chronic pain acceptance were related to improved pain impact (p<.05). Furthermore, a change in psychological factors prior to functional restoration was related to the change in pain impact after functional restoration. However, the addition of CIH therapies to standard rehabilitative care did not result in changes in pain outcomes mediated by the psychological factors.

Conclusions: Although psychological factors were related to pain outcomes, the effect of CIH therapies on chronic pain did not occur via a change in the four psychological factors.

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Conflict of interest statement

Declarations of conflict of interest: none

Figures

Figure 1:
Figure 1:
The Mediation Model a = effect of the treatment condition on the mediator (action theory) b = effect of the mediator on the dependent variable (conceptual theory) c’ = direct effect of the treatment condition on the dependent variable
See this image and copyright information in PMC

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