Stepped-Care Plan Relieves Chronic Musculoskeletal Pain in Randomized Trial

Bair MJ, Ang D, Wuet J, et al. Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts: A Randomized Clinical Trial. JAMA Intern Med. 2015. Published online March 09, 2015 doi:10.1001/jamainternmed.2015.97 March 09, 2015

Ross JS. A Better Pain Plan. JAMA Intern Med. 2015; Published online March 09, 2015. doi:10.1001/jamainternmed.2015.102

A randomized trial of 241 veterans with chronic, disabling musculoskeletal pain of the spine, shoulders, knees and hips compared stepped care with usual care for chronic pain.

Stepped care combined analgesics, self-management strategies, and brief cognitive behavioral therapy. This produced statistically significant reductions in pain-related disability, pain interference and pain severity, compared tousual care.

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Self-management strategies included encouragement to minimize bed rest, return to normal activities, and perform stretches and strengthening exercises including walking.

The editorial highlights the features that can be integrated into any primary care practice: an analgesic treatment algorithm that requires patients to try several different types of medication before opiates, nurses rather than physicians, and the importance of treating mental health symptoms such as depression.