Chronic pain is common, disabling, and costly among veterans and often co-occurs with other conditions such as traumatic brain injury and posttraumatic stress disorder (PTSD). Developing methods to enhance rehabilitation of patients with these conditions is a high priority within the Veterans Health Administration. The proposed study is the next step in the program of research we began with F4306I, Acceptance-based Therapy for Chronic Pain (10/1/06-9/30/09), funded by the VA RR&D Service. Although preliminary data suggest that a brief psychosocial intervention, Acceptance and Commitment Therapy (ACT), is effective at reducing distress and improving quality of life for veterans with chronic pain, and ACT is one of the empirically supported psychotherapies the VA is rolling out nationwide, multiple barriers exist to its dissemination. Many veterans live in rural communities at a distance from a VA medical center, and patients with chronic pain often have mobility limitations or financial or time constraints that make travel difficult. Telehealth can help overcome these barriers. By allowing veterans to access state-of-the-art pain treatment in CBOCs or Vet Centers closer to their homes, the VA can provide rehabilitation services to a larger number of patients who need them. We propose a non-inferiority trial to test the hypothesis that ACT for chronic pain delivered by videoconferencing technology is not inferior to ACT for pain delivered in person. Patients (N = 196) with chronic nonmalignant pain for at least six months will be randomized to receive eight individual sessions of ACT either via telehealth or in person. We hypothesize that: 1) improvement in pain interference associated with ACT delivered via telehealth will not be inferior to that associated with ACT delivered in person; 2) improvements in depression, anxiety, PTSD symptoms, quality of life, activity levels, and sleep quality associated with ACT delivered via telehealth will not be inferior to those associated with ACT delivered in person; and 3) attrition rates will be lower and satisfaction higher for individuals receiving ACT via telehealth than for those receiving ACT in person. We will also conduct exploratory analyses to investigate the impact of cognitive function on treatment and the effect of the intervention on biomarkers of stress and health.
Project Narrative Chronic pain is a serious, disabling, and costly problem among veterans. Although psychosocial interventions that can reduce disability and improve quality of life exist, multiple barriers to access limit their dissemination. Telehealth can help overcome those barriers. We propose to compare a brief form of psychosocial pain treatment delivered in person to the same therapy delivered by videoconferencing technology. We anticipate that telehealth delivery of our acceptance-based pain intervention will provide similar benefits to those obtained with in-person delivery while reducing attrition and increasing satisfaction in a sample of 196 veterans with chronic pain.
