Researchers at Madigan Army Medical Center will soon start studying new ways to address chronic pain thanks to a $1 million, three-year research grant from the U.S. Army Medical Research and Materiel Command.
Madigan's Interdisciplinary Pain Management Clinic is collaborating with the University of Washington to study the effects of adding integrative pain therapies (alternative therapies such as acupuncture, yoga, and biofeedback) to a more traditional outpatient functional restoration program, which is more physical and occupational therapy-centric. While the IPMC currently offers both the integrative pain therapies and the functional restoration program as separate treatment plans, researchers are theorizing that receiving both therapies together, with the alternative treatments implemented first, may be more effective in treating chronic pain.
The issue of chronic pain is a national one, and in fact pain is the number one reason why people seek medical care nationwide, said Dr. Diane Flynn, Madigan's primary care pain management advisor and the lead for the study.
"Of course in the military, the magnitude of the problem is compounded by deployment-related injuries," she said, explaining that Soldiers may be in chronic pain from combat injuries, or wear and tear from wearing heavy body armor and being jostled in tactical vehicles. In addition, the relatively young population of the military means they also see a good number of chronic pain patients for sports-related injuries.
The IPMC's current integrated modalities pain care team program offers twice weekly integrative therapy for six weeks through a mix of chiropractic, acupuncture, biofeedback, occupational and physical therapies, along with education on medical massage and chronic pain.
Their functional restoration program, however, "is all about restoring physical function, so that it's very heavy on physical modalities," Flynn said. Patients spend four hours a day in the gym with physical and occupational therapists, four times a week for three weeks, with their days interspersed with group therapy and group education.
"What functional restoration can do is help to take people from where they are right now physically, (and) encourage them to become more physically active … so that at the end of three weeks, they realize, 'I can do a lot more than I realized and I can do it in a safe way,'" said Flynn.
"What we found is that people do well with both of those programs, they show improvement, especially in their physical functioning … but when they do the programs together, they seem to do better," said Flynn. She explained that if patients are in a lot of pain and they see a chiropractor or acupuncturist first to "decrease the volume of the pain," the pain can become more tolerable before the patients participate in intensive physical therapy.
However, Flynn said that in the world of treating chronic pain, many providers support either integrated (alternative) therapies or the functional restoration campaign, but there's little research supporting a combination of the two.
"Our theory is that if we can decrease pain through integrated modalities, patients will be able to engage in a functional restoration program more actively and have better outcomes," she said.
To test this theory, the IPMC will ask chronic pain patients who are candidates for functional restoration if they would participate in the study. From there, participants will be randomly put in one of two treatment groups: one will engage in integrated therapies before joining in the more intensive functional restoration program, while the other will go directly to the functional restoration program. This second group will retain the option to engage in integrated therapies afterwards, so they can still benefit from the alternative therapies without affecting the study results.
The University of Washington's Department of Anesthesiology and Pain Medicine and Department of Nursing provided guidance on how to design this research, and they will also do the data analysis of the study's findings.
If the study's hypothesis is proven true, its impact on treatment could extend to the Army's other IPMCs, said Flynn.
"I think it has application beyond the Army, because if you look in the medical literature, there's very little information about how integrated modalities complement functional restoration," she said.
Flynn emphasized that the goal of this research is to help reduce chronic pain, not to eliminate it.
"The goal of the research is to improve Soldiers' lives," said Flynn. "We very rarely can eliminate pain when it's chronic; it's more of helping Soldiers cope with pain and helping Soldiers regain confidence in their bodies' ability to function again."
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