Targeting Chronic Pain in Primary Care Settings Using Behavioral Health Consultants: A Pilot Study Implementing Brief...

Area of Science:

• Health Services Research
• Behavioral Medicine
• Pain Management

Background:

• Chronic pain significantly impacts military service members, retirees, and their families.
• Non-pharmacological pain management options are limited within primary care settings in the Military Health System (MHS).
• Integrated behavioral health models offer potential solutions for delivering accessible pain interventions.

Purpose of the Study:

• To evaluate the feasibility and outcomes of Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) delivered by Behavioral Health Consultants (BHCs) in an MHS primary care clinic.
• To assess the effectiveness of BCBT-CP in improving pain intensity, interference, and overall well-being in a military population.
• To determine the potential of BHCs to implement standardized, modular pain interventions within usual care.

Main Methods:

• A prospective, observational pragmatic pilot study involving 44 Department of Defense beneficiaries with chronic pain (≥12 weeks).
• Participants received BCBT-CP as part of usual care, delivered by integrated BHCs within the Primary Care Behavioral Health model.
• Feasibility assessed by enrollment and appointment attendance; outcomes measured using the Defense and Veterans Pain Rating Scale (DVPRS) and Pain, Enjoyment of Life, and General Activity (PEG-3) scale at baseline, during treatment, and at 3- and 6-month follow-ups.

Main Results:

• High feasibility was demonstrated, with 44 of 45 approached patients enrolling and attending a median of 3 appointments.
• Significant improvements were observed in DVPRS pain intensity (p < .001) and interference with activity, sleep, and stress.
• The PEG scale also showed significant improvements (p < .05), indicating better pain management and function.
• No significant changes were detected on the Behavioral Health Measure (BHM-20).

Conclusions:

• Implementing BCBT-CP through BHCs in MHS primary care is feasible and leads to significant short-term improvements in chronic pain outcomes.
• The intervention shows promise for enhancing non-pharmacological pain management within the military healthcare setting.
• Larger trials are recommended to confirm these findings and explore strategies for sustaining treatment benefits over time.