A large number of veterans suffer from distress-based conditions, such as anxiety and depression, putting them at high risk of experiencing persistent pain and prolonged opioid use following surgery. These connections are based on strong and consistent evidence from the literature and our preliminary data. The proposed study adds a 1-day workshop of Acceptance and Commitment Therapy (ACT), followed by an individual booster session, to treatment as usual (TAU) to reduce veterans risk of persistent pain and prolonged opioid use following surgery. ACT has been shown to be effective in reducing chronic pain, anxiety and depression. This pilot study will establish the feasibility and preliminary efficacy of incorporating ACT into treatment as usual (TAU) to preoperatively target distress-based risk factors.
Aim 1 is to establish the feasibility of successfully delivering ACT to at-risk veterans before and after surgery.
Aim 2 is to test the preliminary efficacy of ACT on the length and/or amount of pain and opioid use after surgery. Veterans who are anxious or depressed before surgery will be randomly assigned to receive ACT plus TAU or TAU. Outcomes between the two groups will be compared.
Aim 3 is to see if PROMIS modules, developed by the National Institute of Health, are useful for assessing pain and other symptoms in veterans. Findings from this study will be used to inform the design and implementation of a larger, well controlled, randomized clinical trial that will evaluate the efficacy of ACT plus TAU for at-risk veterans. This study will take place at the Iowa City VA Health Care System. Veterans scheduled for orthopedic surgery in 1 to 3 months who score high for anxiety or depression will be randomly assigned to attend a 1-day ACT workshop preoperatively, with an individualize booster session postoperatively, or to have TAU. Veterans who receive ACT and trainers who provide the treatment will be interviewed to identify barriers and facilitators to providing ACT to at-risk veterans before and after surgery. Other primary outcomes are pain and opioid use after surgery. Factors that may affect these outcomes will also be measured, including anxiety, depression, substance use disorder, post-traumatic stress disorder, and use of other pain meds. We expect to gain important knowledge about ways to best include ACT as part of routine care for veterans requiring surgery and about the preliminary efficacy of ACT for the prevention of persistent pain and prolonged opioid use following surgery.
The proposed research is relevant to public health because it targets psychological distress in veterans to prevent persistent pain and prolonged opioid use after surgery which will have a dramatic impact on veteran quality of life and productivity, including positive effects on mood, daily activities, sleep, cognitive functions, social life, and decreased risk of suicide. This project responds to a specific request for applications to test non-pharmacological approaches to managing pain and co-morbid conditions in U.S. military personnel, veterans, and their families. This project specifically evaluates the feasibility and preliminary efficacy of a 1-day training session and an individual booster session of Acceptance and Commitment Therapy which has been shown to significantly lower distress and disability in patients with chronic pain.