Pain management program outcomes in veterans with chronic pain and comparison with nonveterans

Figures & data

Table 1. Patient demographics

	Veterans	Nonveterans
Mean age (SD)	48.5 (9.5)	48.3 (12.6)
Gender	Men (n = 56) Women (n = 12)	Men (n = 56) Women (n = 12)
Referral source*	VAC (n = 68) Insurance (n = 0) WSIB (n = 0) OHIP (n = 0) Unknown (n = 0)	VAC (n = 0) Insurance (n = 43) WSIB (n = 9) OHIP (n = 9) Unknown (n = 3)
Mean number of years since last employed (SD)	3.7 (3.8)	4.4 (5.9)
Mean number of years since pain problem began (SD)**	16.8 (12.1)	5.0 (5.0)
Mean number of visits to the emergency room (SD)	3.9 (3.9)	2.8 (3.4)
Children	None (n = 13) 1–2 (n = 33) 3+ (n = 22)	None (n = 11) 1–2 (n = 39) 3+ (n = 18)
Marital status	Single (n = 8) Married/common-law (n = 51) Separated/divorced (n = 6)	Single (n = 15) Married/common-law (n = 50) Separated/divorced (n = 11)
Employment status at start of the program*	Employed (n = 7) Unemployed (n = 61)	Employed (n = 26) Unemployed (n = 38)
Number of injuries related to work^a*	0 injuries (n = 1) 1 injury (n = 12) 2 injuries (n = 9) 3+ injuries (n = 45)	0 injuries (n = 25) 1 injury (n = 10) 2 injuries (n = 9) 3+ injuries (n = 7)
Number of injuries for other reasons (e.g., car accident)^a*	0 injuries (n = 21) 1 injury (n = 7) 2 injuries (n = 6) 3+ injuries (n = 6)	0 injuries (n = 7) 1 injury (n = 16) 2 injuries (n = 6) 3+ injuries (n = 14)
Number of visits to family physician^a*	1–4 visits (n = 4) 5–9 visits (n = 6) 10–19 visits (n = 11) 20+ visits (n = 40)	1–4 visits (n = 17) 5–9 visits (n = 16) 10–19 visits (n = 12) 20+ visits (n = 9)
Number of visits to other specialists^a	0–4 visits (n = 34) 5–9 visits (n = 20) 10+ visits (n = 12)	0–4 visits (n = 20) 5–9 visits (n = 18) 10+ visits (n = 17)
PTSD (diagnosis, features, or query)*	Yes (n = 43) No (n = 25)	Yes (n = 25) No (n = 34)

^aSince pain problem began.

*Indicates a significant chi-square test result (P < 0.05).

**Indicates a significant t test result (P < 0.05).

VAC = Veterans Affairs Canada; WSIB = Workplace Safety and Insurance Board; OHIP = Ontario Health Insurance Plan; PTSD = posttraumatic stress disorder.

Table 2. Comparison of scores between veterans and nonveterans at admission and discharge

Session	n^a	Veteran average (SD)	Nonveteran average (SD)	Cohen’s d	P	F
Pain Intensity Scale
Admission Discharge	39	5.5 (1.6) 5.1 (1.6)	5.7 (1.5) 5.5 (1.9)	0.2 0.3	Group = 0.31 Session = 0.10 Interaction = 0.5
Center for Epidemiological Studies Depressed Mood Scale
Admission Discharge	62	32.3 (10.6) 19.5 (10.7)	34.2 (11.1) 24.4 (12.5)	0.2 0.4	Group = 0.06 Session = 0.00 Interaction = 0.09	Session F(1, 61) = 4.27, P < 0.001
Pain Catastrophizing Scale
Admission Discharge	62	30.5 (12.0) 16.1 (9.9)	33.2 (13.1) 25.6 (13.3)	0.2 0.8	Group = 0.02 Session = 0.00 Interaction = 0.01	Interaction F(1, 61) = 7.32, P = 0.01
Clinical Anxiety Scale
Admission Discharge	63	42.4 (17.5) 29.9 (13.5)	42.0 (20.6) 37.6 (18.1)	0.02 0.5	Group = 0.21 Session = 0.00 Interaction = 0.00	Interaction F(1, 62) = 7.49, P < 0.001
Patient Questionnaire of the Primary Care Evaluation of Mental Disorders
Admission Discharge	64	13.8 (3.7) 10.2 (4.1)	13.3 (3.8) 11.6 (4.6)	0.1 0.3	Group = 0.44 Session = 0.00 Interaction = 0.00	Interaction F(1, 63) = 1.73, P < 0.001
Pain Disability Index
Admission Discharge	64	48.4 (8.1) 41.5 (10.1)	47.3 (9.9) 41.2 (12.1)	0.1 0.03	Group = 0.67 Session = 0.00 Interaction = 0.59	Session F(1, 63) = 4.70, P < 0.01
Tampa Scale of Kinesiophobia
Admission Discharge	59	32.4 (5.9) 22.1 (6.0)	31.2 (7.0) 27.8 (7.8)	0.19 0.82	Group = 0.05 Session = 0.00 Interaction = 0.00	Interaction F(1, 58) = 18.31, P < 0.001
Chronic Pain Acceptance Questionnaire Activities of Engagement
Admission Discharge	64	27.9 (10.5) 37.5 (8.6)	24.4 (12.2) 32.0 (11.1)	0.31 0.55	Group = 0.00 Session = 0.00 Interaction = 0.32	Group F(1, 63) = 19.64, P < 0.001 Session F(1, 63) = 8.61, P < 0.001
Chronic Pain Acceptance Questionnaire Pain Willingness
Admission Discharge	64	18.1 (7.6) 22.3 (7.63)	16.0 (8.2) 18.6 (8.1)	0.27 0.47	Group = 0.01 Session = 0.00 Interaction = 0.24	Group F(1, 63) = 18.23, P < 0.001 Session F(1, 63) = 3.83, P < 0.001
Chronic Pain Acceptance Questionnaire Total
Admission Discharge	64	46.0 (14.8) 59.7 (13.8)	40.4 (16.1) 50.6 (15.2)	0.37 0.63	Group = 0.00 Session = 0.00 Interaction = 0.15	Group F(1, 63) = 26.30, P < 0.001 Session F(1, 63) = 9.34, P < 0.001
Sensitivity to Pain Traumatization Scale
Admission Discharge	45	22.0 (9.5) 18.0 (8.2)	27.0 (11.1) 22.8 (10.5)	0.48 0.51	Group = 0.01 Session = 0.00 Interaction = 0.90	Group F(1, 44) = 9.10, P = 0.01 Session F(1, 44) = 2.72, P < 0.001
Pain Stages of Change Questionnaire Pre-contemplation
Admission Discharge	63	2.9 (0.6) 2.0 (0.6)	3.1 (0.7) 2.5 (0.7)	0.30 0.75	Group = 0.00 Session = 0.00 Interaction = 0.02	Interaction F(1, 62) = 7.74, P = 0.02
Pain Stages of Change Questionnaire Contemplation
Admission Discharge	63	3.9 (0.6) 4.1 (0.5)	3.6 (0.7) 3.9 (0.5)	0.41 0.46	Group = 0.00 Session = 0.00 Interaction = 0.76	Group F(1,62) = 1.85, P < 0.001 Session F(1, 62) = 11.27, P < 0.001
Pain Stages of Change Questionnaire Action
Admission Discharge	63	3.0 (0.8) 4.2 (0.4)	3.1 (0.8) 4.0 (0.50)	0.2 0.45	Group = 0.39 Session = 0.00 Interaction = 0.00	Interaction F(1, 62) = 1.98, P < 0.001
Pain Stages of Change Questionnaire Maintenance
Admission Discharge	63	3.1 (0.8) 4.3 (0.5)	2.9 (0.8) 3.6 (0.9)	0.16 0.86	Group = 0.61 Session = 0.00 Interaction = 0.06	Session F(1, 62) = 1.02, P < 0.001
Chronic Pain Coping Inventory Guarding
Admission Discharge	49	53.0 (7.7) 49.4 (7.3)	55.1 (6.3) 51.3 (7.9)	0.29 0.26	Group = 0.14 Session = 0.00 Interaction = 0.96	Session F(1, 48) = 3.03, P < 0.001
Chronic Pain Coping Inventory Resting
Admission Discharge	49	51.0 (7.9) 51.4 (5.8)	56.3 (8.4) 54.6 (9.3)	0.65 0.41	Group = 0.00 Session = 0.51 Interaction = 0.18	Group F(1, 48) = 3.69, P < 0.001
Chronic Pain Coping Inventory Asking for Assistance
Admission Discharge	49	48.5 (6.5) 46.7 (7.1)	53.0 (8.1) 51.7 (7.8)	0.61 0.66	Group = 0.00 Session = 0.02 Interaction = 0.78	Group F(1, 48) = 0.65, P < 0.001 Session F(1, 48) = 6.75, P = 0.02
Chronic Pain Coping Inventory Exercise/Stretch
Admission Discharge	49	48.3 (10.3) 60.9 (6.4)	51.8 (9.0) 60.8 (7.6)	0.36 0.02	Group = 0.19 Session = 0.00 Interaction = 0.06	Session F(1, 48) = 0.01, P < 0.001
Chronic Pain Coping Inventory Relaxation
Admission Discharge	49	52.9 (8.2) 61.3 (6.2)	53.7 (7.9) 62.6 (7.4)	0.11 0.19	Group = 0.39 Session = 0.00 Interaction = 0.80	Session F(1, 48) = 1.69, P < 0.001
Chronic Pain Coping Inventory Task Persistence
Admission Discharge	49	46.9 (8.3) 41.7 (7.1)	41.6 (9.2) 39.9 (8.1)	0.61 0.24	Group = 0.01 Session = 0.00 Interaction = 0.05	Interaction F(1, 48) = 0.67, P = 0.05
Chronic Pain Coping Inventory Coping Self-Statements
Admission Discharge	49	47.4 (7.4) 52.8 (7.2)	50.9 (8.5) 54.3 (9.0)	0.44 0.18	Group = 0.07 Session = 0.00 Interaction = 0.18	Session F(1, 48) = 1.68, P < 0.001
Chronic Pain Coping Inventory Pacing
Admission Discharge	49	48.2 (7.6) 54.6 (4.9)	52.4 (6.4) 56.2 (6.9)	0.59 0.27	Group = 0.01 Session = 0.00 Interaction = 0.14	Group F(1, 48) = 19.11, P = 0.01 Session F(1, 48) = 4.51, P < 0.001
Chronic Pain Coping Inventory Seeking Social Support
Admission Discharge	49	50.4 (7.0) 50.9 (6.2)	50.9 (7.5) 51.8 (7.4)	0.08 0.13	Group = 0.55 Session = 0.29 Interaction = 0.79

^aNumber of matched pairs.

Group = Group (veteran/nonveteran) difference; Session = Session (admission/discharge) difference; Interaction = Group by session interaction (combination of group and session differences).

Table 3. Comparison of discharge questionnaire scores between veterans and nonveterans

Discharge questionnaire	n^a	Veteran average (SD)	Nonveteran average (SD)	Cohen’s d	P
Pain Program Satisfaction Questionnaire	63	37.0 (5.6)	35.5 (5.6)	0.25	0.19
Self-Evaluation Scale	63	3.6 (0.9)	3.2 (1.1)	0.39	0.02*
Patient Evaluation Scale^b	55	3.7 (0.8)	3.2 (0.9)	0.57	0.00*
Patient Evaluation of Program Benefit
Physical domain	62	6.3 (2.0)	6.3 (2.3)	0	1.00
Emotional/mental domain	61	6.7 (1.8)	6.6 (2.4)	0.02	0.89
Social domain	54	6.6 (2.1)	6.4 (1.9)	0.09	0.61
Case Manager Evaluation of Program Benefit
Physical domain	54	6.5 (1.4)	5.8 (2.1)	0.40	0.02*
Emotional/mental domain	52	6.7 (1.6)	5.9 (2.0)	0.43	0.02*
Social domain	54	6.7 (1.8)	6.0 (1.8)	0.39	0.04*

^aNumber of matched pairs.

^bCase manager’s evaluation of the patient.

*Indicates a significant result.

Table A1. Post hoc multiple comparisons analysis

Measure	Scheffe tests	Difference	Comparison values (absolute)
PCS	8.26	Veterans: Session	14.39*
		Nonveterans: Session	7.64
		Admission: Group	2.69
		Discharge: Group	9.44*
CAS	9.84	Veterans: Session	12.51*
		Nonveterans: Session	4.67
		Admission: Group	0.35
		Discharge: Group	7.96
PQ	2.62	Veterans: Session	3.59*
		Nonveterans: Session	1.68
		Admission: Group	0.48
		Discharge: Group	1.43
TSK	8.49	Veterans: Session	10.34*
		Nonveterans: Session	3.41
		Admission: Group	1.27
		Discharge: Group	5.66
PSOCQ Pre-contemplation	0.37	Veterans: Session	0.86*
		Nonveterans: Session	0.55*
		Admission: Group	0.20
		Discharge: Group	0.51*
PSOCQ Action	0.55	Veterans: Session	1.33*
		Nonveterans: Session	0.88*
		Admission: Group	0.15
		Discharge: Group	0.30
CPCI Task Persistence	4.249	Veterans: Session	5.14*
		Nonveterans: Session	1.69
		Admission: Group	5.31*
		Discharge: Group	1.86

* Indicates a significant difference.

PCS = Pain Catastrophizing Scale; CAS = Clinical Anxiety Scale; PQ = patient questionnaire; TSK = Tampa Scale of Kinesiophobia; PSOCQ = Pain Stages of Change Questionnaire; CPCI = Chronic Pain Coping Inventory.

Table B1. Chronicity correlations

	PCSD	CPAQAD	CPAQPA	CPAQTD	PSOCQPD	PSOCQCD	SPTSD
Chronicity	−0.25**	0.26**	0.18*	0.20*	−0.23*	0.22*	−0.24*

* Correlation is significant at the 0.05 level.

** Correlation is significant at the 0.01 level.

PCSD = Pain Catastrophizing Scale at discharge; CPAQAD = Chronic Pain Acceptance Questionnaire Activities Engagement at discharge; CPAQPA = Chronic Pain Acceptance Questionnaire Pain Willingness at admission; CPAQTD = Chronic Pain Acceptance Questionnaire Total at discharge; PSOCQPD = Pain Stages of Change Questionnaire Pre-contemplation at discharge; PSCOCQCD = Pain Stages of Change Questionnaire Contemplation at discharge; SPTSD = Sensitivity to Pain Traumatization Scale at discharge.

Table C1. MMPI-2 subscale scores

Scale	n	Veteran average (SD)	Nonveteran average (SD)	P
VRIN	45 7	Men = 54.00 (11.88) Women = 52.29 (6.05)	Men = 52.13 (9.29) Women = 57.43 (10.94)	0.64 0.14
F	45 7	Men = 65.84 (15.63) Women = 69.71 (13.43)	Men = 67.78 (15.29) Women = 67.29 (14.07)	0.53 0.86
Fb	45 7	Men = 62.69 (20.38) Women = 64.71 (19.92)	Men = 64.93 (20.61) Women = 65.14 (20.65)	0.15 0.52
Fp	45 7	Men = 50.29 (12.14) Women = 61.57 (12.09)	Men = 54.31 (11.83) Women = 53.57 (10.18)	0.33 0.81
FBS	45 7	Men = 77.36 (16.88) Women = 80.86 (12.60)	Men = 82.42 (14.23) Women = 82.00 (8.35)	0.50 0.29
L	45 7	Men = 53.76 (11.25) Women = 50.00 (8.35)	Men = 59.58 (9.87) Women = 51.43 (8.98)	0.87 0.98
K	45 7	Men = 46.62 (10.56) Women = 46.14 (12.08)	Men = 46.00 (8.51) Women = 44.57 (10.63)	0.87 0.90
S	45 7	Men = 44.93 (9.10) Women = 46.00 (11.71)	Men = 44.76 (9.96) Women = 43.86 (10.59)	0.84 0.04*
Hs	45 7	Men = 80.04 (14.17) Women = 81.86 (11.07)	Men = 84.47 (10.69) Women = 81.86 (8.29)	0.28 0.51
D	45 7	Men = 78.58 (14.39) Women = 83.29 (17.85)	Men = 84.89 (13.32) Women = 86.00 (10.25)	0.97 0.09
Hy	45 7	Men = 79.58 (14.45) Women = 80.86 (14.59)	Men = 85.60 (16.04) Women = 87.14 (15.05)	0.36 0.35
Pd	45 7	Men = 64.71 (12.83) Women = 67.86 (6.49)	Men = 63.64 (11.21) Women = 67.86 (6.49)	0.25 0.37
Mf	45 7	Men = 48.11 (7.66) Women = 62.00 (11.82)	Men = 48.22 (9.72) Women = 50.00 (10.65)	0.33 0.31
Pa	45 7	Men = 65.82 (17.05) Women = 67.71 (14.06)	Men = 67.64 (15.55) Women = 64.57 (11.18)	0.46 0.79
Pt	45 7	Men = 74.76 (15.87) Women = 74.57 (11.28)	Men = 76.78 (14.54) Women = 73.57 (5.88)	0.96 0.26
Sc	45 7	Men = 76.24 (16.88) Women = 78.86 (9.34)	Men = 74.87 (16.67) Women = 76.00 (9.50)	0.94 0.94
Ma	45 7	Men = 56.16 (13.96) Women = 57.71 (15.77)	Men = 53.02 (9.37) Women = 50.43 (8.56)	0.13 0.49
Si	45 7	Men = 57.36 (12.91) Women = 60.57 (15.09)	Men = 60.87 (10.39) Women = 59.71 (8.90)	0.59 0.99

* Indicates significant result (P < 0.05).

MMPI-2 = Minnesota Multiphasic Personality Inventory-2; VRIN = Variable Response Inconsistency; F = Infrequency; Fb = Back F; Fp = Psychopathology; FBS = Symptom Validity; L = Lie; K = Correction; S = Superlative Self-Presentation; Hs = Hypochondriasis; D = Depression; Hy = Hysteria; Pd = Psychopathic Deviate; Mf = Masculinity/Femininity; Pa = Paranoia; Pt = Psychasthenia; Sc = Schizophrenia; Ma = Hypomania; Si = Social Introversion.

Table D1. Benefit measure correlations

	PSES	CSES	PPSQ	PPB	PEB	PSB	CPB	CEB	CSB
PSES	1
CSES	0.515	1
PPSQ	0.470	0.369	1
PPB	0.421	0.361	0.420	1
PEB	0.461	0.309	0.416	0.628	1
PSB	0.458	0.330	0.430	0.563	0.610	1
CPB	0.440	0.752	0.341	0.410	0.273	0.238	1
CEB	0.480	0.763	0.357	0.396	0.382	0.305	0.740	1
CSB	0.422	0.650	0.380	0.345	0.378	0.427	0.659	0.768	1

PSES = patient Self-Evaluation Scale; CSES = case manager Self-Evaluation Scale; PPSQ = Pain Program Satisfaction Questionnaire; PPB = patient physical benefit; PEB = patient emotional benefit; PSB = patient social benefit; CPB = case manager physical benefit; CEB = case manager emotional benefit; CSB = case manager social benefit.