A stepped-care intervention balancing pain relief, self-management strategies, and cognitive-behavioral therapy achieves significant improvements in chronic pain compared with usual care by pharmacological and nonpharmacological means, according to a paper published in JAMA Internal Medicine.

A randomized, controlled trial of 241 veterans with chronic and disabling musculoskeletal pain found that veterans of the Iraq and Afghanistan conflicts treated with the stepped intervention experienced a more than twofold greater reduction in Roland Morris Disability Scale and Graded Chronic Pain Scale severity scores, compared to those in the control arm (–3.7 vs. –1.7, P = .002, and –11.1 vs. –4.5, P = .001) at 9 months after randomization.

The intervention involved 12 weeks of optimized analgesic therapy combined with the teaching of pain self-management strategies, followed by an additional 12 weeks including adapted cognitive-behavioral therapy (JAMA Intern. Med. 2015 March 9 [doi:10.1001/jamainternmed.2015.97]).

“The patients spoke about their evolving understanding of their pain experience during the trial and how this new understanding helped them manage their pain more effectively,” wrote Dr. Matthew J. Bair of the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, and his associates.

Among the limitations cited by Dr. Bair is that the participants were recent veterans with chronic musculoskeletal pain, so the results might not be generalizable to veterans from earlier wars or to nonveterans.

The study was supported by Veterans Affairs Rehabilitation Research and Development, and one author reported unrelated honoraria from Eli Lilly.