Role of Active Versus Passive Complementary and Integrative Health Approaches in Pain Management

David Cosio, Erica Lin, David Cosio, Erica Lin

Abstract

Background: A general conclusion about the treatment of chronic, noncancer pain is that the results from traditional, passive modalities are disheartening. Perhaps this may be due to the propensity of patients to seek out passive versus active treatments. In pain management, active treatments should be the primary focus, with passive interventions as an adjunct.

Objective: The current study tested the hypotheses that Veterans would report a greater significant increase in active versus transitional and active versus passive complementary and integrative health (CIH) utilization after completing a formal pain education program.

Methods: The current study is a secondary analysis of existing data from an original study. The current study used a quasi-experimental, 1-group, pre-/posttest design. One hundred three Veterans completed a 12-week, "Pain Education School" program at a Midwestern VA Medical Center between November 4, 2011, and October 26, 2012. As part of the introduction and conclusion of the program, all Veterans completed a pre- and posteducation assessment which included an adaptation of the Complementary and Alternative Medicine Questionnaire©, SECTION A: Use of Alternative Health Care Providers measure.

Results: Significant differences were found between the pre- and posttest measures of use of active (P = .000) (p<.001), transitional (P = .011), and passive (P = .007) CIH modalities.

Conclusion: The current findings suggest that an educational intervention in conjunction with the availability of treatment options has the potential to increase the use of those treatments. The current pain education program also seems to be aligned with the goal of pain self-management, which is to utilize more active interventions as a primary therapy.

Keywords: Veterans; active treatments; complementary and integrative health; pain education; passive treatments.

Figures

Figure 1.
Figure 1.
Complementary and Integrative Health Findings.
Figure 2.
Figure 2.
Flowchart of Study Participants.
Figure 3.
Figure 3.
Pre- and Postpercentage of (CIH) Users.

References

    1. Turk D, Wilson H, Cahana A. Treatment of chronic non-cancer pain. Lancet. 2011;377: 2226–2235.
    1. Loranger L. Good practice: active vs. passive treatments. Physiotherapy Alberta News. . Published 2015. Accessed November 4, 2015.
    1. Arnstein P. Clinical Coach for Effective Pain Management. Philadelphia, PA: F. A. Davis Company, 2010.
    1. Anderson B. Randomized clinical trial comparing active versus passive approaches to the treatment of recurrent and chronic low back pain [Dissertation]. Coral Gables, FL: University of Miami, 2005.
    1. Mannion A, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine. 1999;24:2435–2448.
    1. van Tulder M, Ostelo R, Vlaeyen J, Linton S, Morley S, Assendelft W. Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine. 2000;25:2688–2699.
    1. Aktivortho. Solutions-Passive vs. Active Therapy. . Accessed November 4, 2015.
    1. van Tulder M, Koes B, Bouter L. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine. 1997;22:2128–2156.
    1. Aure O, Nilsen J, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine. 2003;28:525–531.
    1. Haas M, Groupp E, Kraemer D. Dose-response for chiropractic care of chronic low back pain. Spine. 2004;4:574–583.
    1. Accident Compensation Corporation. The New Zealand Acute Low Back Pain Guide and Assessing Yellow Flags in Acute Low Back Pain: Risk Factors for Long-term Disability and Work Loss. Wellington, New Zealand: New Zealand Guideline Group, 2003.
    1. Reitman C, Esses S. Conservative options in the management of spinal disorders, Part I. Bed rest, mechanical, and energy-transfer therapies. Am J Orthop. 1995;24:109–116.
    1. Moskowitz M, Golden M. Neuroplastix: change the brain; relieve the pain; transform the person. . Published 2015. Accessed November 4, 2015.
    1. Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett. 1997;224:5–8.
    1. Bode G. Chiropractic … Active vs. passive care it makes all the difference in the world. . Published 2010. Accessed November 4, 2015.
    1. National Center for Complementary and Integrative Health. Chronic pain: in depth. . Published 2018. Accessed February 14, 2018.
    1. Keller A, Hayden J, Bombardier C, van Tulder M. Effect sizes of non-surgical treatments of non-specific low-back pain. Eur Spine J. 2007;16:1776–1788.
    1. Kralik D, Koch T, Price K, Howard N. Chronic illness self-management: taking action to create order. J Clin Nurs. 2004;13:259–267.
    1. Cosio D, Lin E. Using patient pain education to increase complementary & alternative treatment utilization in U.S. Veterans with chronic, non-cancer pain. Complement Ther Med. 2015;23:413–422.
    1. Kinsinger L, Lewis S, Strickland R. VA National Center for Health Promotion and Disease Prevention. Put prevention into VA practice: a step-by-step guide to successful program implementation. . Published 2004. Accessed January 23, 2012.
    1. Ferrell B, Rhiner M, Ferrell B. Development and implementation of a pain education program. Cancer. 1993;72:3426–3432.
    1. Cosio D, Hugo E, Roberts S, Schaefer D. A pain education school for Veterans with chronic non-cancer pain: putting prevention into VA practice. Fed Pract. 2012;29:23–29.
    1. Cosio D, Lin E. Effects of a pain education program for Veterans with chronic, non-cancer pain: a pilot study. J Pain Palliat Care Pharmacother. 2013;27:340–349.
    1. Simmons E, Cosio D, Lin E. Using audience response systems to enhance chronic, non-cancer pain knowledge acquisition among Veterans. Telemed e-Health. 2015;21:557–563.
    1. California Health Interview Survey.. Complementary and Alternative Medicine Questionnaire: A CHIS 2001 Follow-back Study. Oakland, CA: The Regents of the University of California, 2003.
    1. Blankers M, Koeter M, Schippers G. Missing data approaches in eHealth research: simulation study and a tutorial for non-mathematically inclined researchers. J Med Internet Res. 2010;12:e54.
    1. Streiner D, Geddes J. Intention to treat analysis in clinical trials when there are missing data. Evid Based Mental Health. 2001;4:70–71.
    1. Dupont W, Plummer W. PS: Power and sample size calculation version 3.0. . Published 2009. Accessed March 12, 2013.
    1. VHA Complementary and Integrative Health Services (formerly CIH). Healthcare Analysis & Information Group (HAIG). Washington, DC. . Published 2015. Accessed May 3, 2016.
    1. American Community Survey: Profile of Veterans. Data from the American Community Survey. National Center for Veterans Analysis and Statistics. . Published 2009. Accessed February 23, 2012.

Source: PubMed

3
Abonner