Pain intervention less effective for military members who ‘pain catastrophize,’ according to UIC study

A third or more of U.S. Army service members suffer from chronic pain, according to estimates, and it’s a leading cause of disability and release from active duty.

A new study led by UIC College of Nursing postdoctoral research associate Dahee Wi looked at how a cognitive behavioral therapy intervention affected pain management among active-duty service members. She found that the intervention tended not to be as effective for participants who had high levels of “pain catastrophizing,” which means the tendency to ruminate on pain, expect the worst outcomes of pain and have feelings of hopelessness. The paper was published in the journal Military Medicine.

“The major takeaway from this study is that we need a more tailored intervention for those who have higher baseline levels of pain catastrophizing,” Wi said.

A more personalized approach could be integrated into group settings, according to the paper, leveraging the benefits of group therapy while addressing specific patient needs.

The study engaged approximately 150 active-duty service members in 60- to 90-minute cognitive behavioral therapy sessions that targeted chronic pain once a week for five to six weeks. The researchers looked to cognitive behavioral therapy because it is a widely used and accepted psychological treatment that aims to lessen pain intensity and psychological distress by improving a person’s ability to cope with their pain.

Nearly three-quarters of participants reported experiencing pain on a daily or near-daily basis. Musculoskeletal pain emerged as the predominant pain type.

When they entered and exited the study, participants completed an assessment tailored for patients experiencing chronic pain, which included a pain catastrophizing scale, a self-reported questionnaire that assesses a person’s response to anticipated or actual pain.

By applying a statistical analysis, Wi and her co-authors identified two classes of nearly equal size with distinct pain impact responses. The class who experienced pain improvement had lower levels of depression before the intervention. The class that did not experience improvement had higher levels of pain catastrophizing before treatment.

The study reinforced previous research findings that high levels of pain catastrophizing are correlated with poorer treatment outcomes, according to the paper.

Wi said she is continuing to explore non-pharmacological treatments for chronic pain in her program of research.

The study was funded with grants from the Army and the National Institutes of Health, both of which are led by principal investigator Ardith Doorenbos. Doorenbos, the Harriet H. Werley Endowed Chair for Nursing Research, was also co-author on the paper, along with UIC Nursing’s Alana Steffen, research associate professor; Chang Park, research assistant professor; and Larisa Burke, senior research specialist. Diane Flynn and Jeffrey Ransom at the Madigan Army Medical Center were also co-authors.