Evaluation of Stepped Care for Chronic Pain in Iraq/Afghanistan Veterans (ESCAPE)
Summary
The purpose of this study is to determine if a stepped-care intervention makes pain symptoms better and reduces activity limitations because of pain. Our two primary hypotheses are that in OIF/OEF veterans with chronic pain: 1. Stepped care is more effective than usual care in reducing pain-related disability 2. Stepped care is more effective than usual care in reducing psychological distress
Timeline
- Start
- 2007-12
- Primary completion
- 2012-05
- Completion
- 2012-09
Outcome
Met primary endpoint
paper 3.7 (95% CI, -4.5 to -2.8) points in the intervention group (between-group difference, -1.9 [95% CI, -3.2 to -0.7] points; P=.002). PMID 25751701 ↗
paper A stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity PMID 25751701 ↗
Publications
- Results Kroenke K, Bair MJ, Damush TM, Wu J, Hoke S, Sutherland J, Tu W. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. JAMA. 2009 May 27;301(20):2099-110. doi: 10.1001/jama.2009.723.
- Kroenke K, Wu J, Yu Z, Bair MJ, Kean J, Stump T, Monahan PO. Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials. Psychosom Med. 2016 Jul-Aug;78(6):716-27. doi: 10.1097/PSY.0000000000000322.
- Bair MJ, Ang D, Wu J, Outcalt SD, Sargent C, Kempf C, Froman A, Schmid AA, Damush TM, Yu Z, Davis LW, Kroenke K. Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts: A Randomized Clinical Trial. JAMA Intern Med. 2015 May;175(5):682-9. doi: 10.1001/jamainternmed.2015.97.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Acetaminophen | Small molecule | 300 mg | — |
| Subject | Acetaminophen | Small molecule | 500 mg | — |
| Subject | Amitriptyline | Small molecule | 100 mg | — |
| Subject | Codeine | Small molecule | 30 mg | — |
| Subject | Gabapentin | Unknown | 900 mg | — |
| Subject | Gabapentin | Unknown | 1200 mg | — |
| Subject | Hydrocodone | Unknown | 5 mg | — |
| Subject | Nortriptyline | Small molecule | 100 mg | — |
| Subject | Tramadol | Other / unclassified | 100 mg | — |
| Subject | Venlafaxine | Small molecule | — | — |
| Subject | carbemazepine | Unknown | — | — |