Intensive Treatment of Chronic Pain and PTSD for OEF/OIF Veterans Objectives: The primary objective of this study is to evaluate the efficacy of an intensive integrated treatment for Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans with comorbid chronic pain and posttraumatic stress disorder (PTSD). A secondary objective is to examine potential mechanisms of action that might account for improvements in pain or PTSD. Third, exploratory analyses will be conducted to assess the relationship between participation in treatment and cognitive functioning. It is hypothesized that 1) participants receiving the intensive treatment (PT) will report significantly greater decreases in symptoms of pain and PTSD from pre-treatment to post-treatment when compared to participants randomized to a standard care (SC) condition, and 2) participants receiving PT will show greater maintenance of change on measures of pain and PTSD at 3 months following the completion of treatment when compared to participants randomized to the SC condition. Research Design: The proposed study is a two treatment condition (Intensive Integrated Pain and PTSD Treatment (PT) vs. Standard Care (SC)) by three evaluation period (pre-treatment, post-treatment, and 3-month follow-up) repeated measures design with multiple dependent measures. Methodology: Participants will be 102 OEF/OIF veterans receiving care in the VA Boston and VA Connecticut Healthcare Systems with a co-morbid diagnosis of chronic pain and PTSD. Patients will be eligible to participate if they have constant pain of at least three months duration with a neurologic or musculoskeletal etiology. Patients must also meet DSM-IV diagnostic criteria for PTSD. Patients with life threatening or acute physical illness, current alcohol or substance abuse, current psychosis or suicidal ideation, and individuals seeking pain treatment such as surgical interventions will be excluded. Interview, self-report methodology, and neuropsychological testing will be utilized to conduct participant assessments. Participants randomized to the PT condition will attend 6 bi-weekly outpatient therapy sessions conducted in an individual format of 90 minutes in duration. Participants randomized to the SC condition will continue to receive standard medical care through the VA. Analyses will examine the effects of each condition as well as between group effects.
Operations Enduring and Iraqi Freedom (OEF/OIF) have resulted in a growing number of injured soldiers who have been evacuated to the United States for comprehensive care related to both physical and psychological trauma, most commonly pain and Post-Traumatic Stress Disorder (PTSD). These disorders tend to co-occur and result in high levels of distressing symptoms. Thus, it is imperative to develop effective, time-efficient treatments for these disorders before they become chronic and resistant to change. This study investigates the treatment of chronic pain and PTSD in OEF/OIF veterans through a brief, integrated treatment format. The study goals are consistent with the VHA National Pain Management Strategy, which assures that all persons cared for in the VA healthcare system can reliably count on prompt and appropriate treatment of pain. This study ultimately aims to help OEF/OIF veterans who are suffering socially, vocationally, and personally due to their pain and PTSD and aims to help veterans return quickly to a more adaptive, healthy daily life.
