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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Article info
Publication history
Published online: January 16, 2023
Accepted:
December 23,
2022
Received in revised form:
December 13,
2022
Received:
September 8,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
