We are all well aware of how the U.S. military has fought hard in Iraq and Afghanistan. The work load is high in such states, given the stressful environment and limited facilities. Both of these result in different kinds of health problems in military men, the commonest being chronic muscular pains. Yet, very little has been done to help U.S. military veterans who have returned from Iraq or Afghanistan, to manage the incapacitating chronic pain that they are left with. A new study now shines light on a potential solution for military members and others!

Researcher Matthew Bair, M.D. from the VA and Regenstrief Institute, lead a randomized controlled ESCAPE trial (Evaluation of Stepped Care for Chronic Pain). He noted-

  •  Due to pain, daily chores become very difficult.
  • Pain interferes with day to day work.
  • Pain hampers our ability to perform the best.
  • Pain is disabling and a critical health issue in numerous veterans.
  • As a result of suffering from chronic pain, there were lengthy deployments.
  • Medical treatment was able to provide some relief, but it was incomplete and lasted for only a short time.
  • Not much has been achieved by current pain medications.

The trial participants-

Chronic pain of moderate to severe intensity lasting for a duration of more than 3 months was common to all veterans enrolled in the study. Two-thirds of the study patients had served in the army, 88 percent were males, and 77 percent were white. The mean age was slightly under 37 years.

The Solution-A new study by researchers from the Richard L. Roudebush from the VA Medical Center in Indianapolis, reports that a ‘stepped-care’ strategy improved function and decreased the pain severity, producing at least a 30 percent improvement in pain-related disability.

ESCAPE studied 241 veterans of Operations Enduring Freedom, Iraqi Freedom and New Dawn who suffer from musculoskeletal pain of the back, knee, neck or shoulder. Dr. Bair and colleagues developed a two-step program combining analgesics, self-management strategies and cognitive behavioral therapy. In the ESCAPE study, the pain was reduced by 30 percent and the reduced-pain period persisted for nine long months. This is clinically extremely important for patients.

2 step therapy-

The first step of the therapy was 12 weeks of treatment with common pain killers like acetaminophen, naproxen sodium, opioids, etc. Along with this, the veterans were taught pain self-management strategies such as deep breathing and other relaxation techniques.

The second step included 12 weeks of cognitive behavioral therapy for both pain and depression drawing upon evidence-based psychological treatments.

Nurse care managers provided the ESCAPE program to the veterans. The nurses supported them during periods of deployment, helped them to counter maladaptive thought. They would also explain to the veterans that they could not undertake difficult physical activities that they had enjoyed before deployment. They needed to find a substitute which is less rigorous, such as swimming.

Veterans who were given the two-step ESCAPE program showed –

  • an increase in Function
  • reduction in the intensity of pain
  • better mood
  • improvement in interpersonal relationships and social activity
  • enhanced capacity to work
  • good sleep and enjoyed life much more than before

Educational handouts on musculoskeletal pain were provided to study patients randomized to usual care. They also received advise from their physicians and discussed their pain with them. Nonstop medications, clinic visits, specialty recommendations and other care as usual were given to these patients.

This 2 step pain management strategy can also be used by elderly persons suffering from chronic pain, who aren’t receiving significant relief from medications, surgery, etc.

Contributed by Dr. Rachita Narsaria, MD


Indiana University. “Two-step treatment improved function, decreased pain severity in veterans.” ScienceDaily. ScienceDaily, 9 March 2015. <www.sciencedaily.com/releases/2015/03/150309123948.htm>.