(May 2001) Stepped Care for Back Pain: Activating Approaches for Primary Care
Interventions that encourage return to normal function and reduce fear of physical activity have been shown to improve outcomes for patients with back pain, but routine medical care for back pain often does not provide such interventions. This paper proposes a stepped-care approach that addresses the functional outcomes of back pain. Step 1, which is relevant to most patients, addresses the common fears of patients with back pain and encourages patients to resume normal activities. Step 2, which targets the substantial minority of patients who require more than simple advice to resume activities, provides brief, structured interventions that support physical exercise and return to normal activities. Step 3 targets patients who require more intensive interventions, including treatment of psychological illness when present, before they can return to normal activities in work and family life.
Do you notice something missing in this approach to treatment? Shouldn’t there be a goal to treat and reduce pain? By pushing (forcing) patients to return to normal activities, isn’t that creating a potential for more damage and pain?
The paper points out that the VA has not lived up to its own standards.
Minnesota U.S. Rep. Tim Walz, a veteran, rightly points out that the Veterans Health Administration has failed to fully implement a best-practices medical treatment blueprint — the Stepped Care Model of Pain Management — that was established by a system wide “Pain Directive” in 2009. Walz authored the 2008 legislation that led to the pain directive’s creation.
Nimmo pointed out in his op-ed, Here at Huntington, we are offering complementary and alternative therapies, including acupuncture, animal-assisted therapy and art therapy.
Chiropractic services are available through the Veteran’s Choice program. We have an interdisciplinary pain team working with providers to find alternative treatments that will help reduce a veteran’s long-term dependence on opioids…
Do you notice something missing here? The goal should be to treat and reduce pain, not just to reduce long-term dependence on opioids (which is another way to say addiction).
(May 2015) Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts: A Randomized Clinical Trial