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Chronic pain study suggests medication treatment is better than therapy



A study on chronic low back pain among veterans taking long-term opioids showed that targeted medication treatment resulted in better outcomes compared to cognitive behavioral therapy, but that the results did not provide a clear indication of which approach is better.

Researchers who published their findings in the online Journal of the American Medical Association on Thursday concluded that the findings “indicate that a collaborative medication optimization approach has a statistically significant but clinically modest advantage over CBT over 12 months.”

With 261 veterans involved in the study, the researchers reviewed cases and treatment plans with physicians and pharmacist investigators during weekly meetings for 1

31 of them, adjusting pain medications as needed. The other 130 veterans received eight, 45-minute cognitive behavioral therapy sessions over nine months, focusing on “barrier identification, skill learning and practice” and “reflection, practice tasks and goal setting” to manage their pain.

The study measured “brief pain inventory” scores among participants at six and 12 months, finding that 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 pain impact. Secondary outcomes were also measured, including pain-related disability, pain catastrophizing, self-reported substance abuse, health-related quality of life, depression, and anxiety.

Researchers conclude that the results between the two approaches, which found managed medication to be the better approach, “may not be clinically meaningful or generalizable to non-veteran populations” and that this “finding suggests that both pharmacological and behavioral approaches are reasonable alternatives for chronic pain.”

The study was conducted by researchers from eight institutions, including the Indiana University School of Medicine in Indianapolis, the Veterans Affairs Health Services Research & Development Center for Health Information and Communication and the Roudebush Veterans Administration Medical Center in Indianapolis.


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