Over the next few years, University of Iowa faculty will assist combat veterans in their battles with chronic pain and opioid dependence.

Barbara Rakel, an associate professor of nursing, will team up with psychologists to offer pre-operative workshops, as well as post-operative phone check-ins, to veterans undergoing orthopedic surgery using experimental pre-emptive psychotherapy techniques.

“Addressing distress-based risk factors prior to surgery in an innovative delivery format, which patients may be better able to participate in, has high potential to affect pain outcomes,” said Kristen Huntley, the program director of the National Institute of Health Division of Extramural Research.

The grant allows her and her colleagues to pursue a two-year feasibility study on psychotherapy methods that may help veterans deal with post-operative chronic pain while attempting to prevent the development of opioid addiction.

Chronic pain, according to a 2011 Institute of Medicine report, affects nearly 100 million Americans at an annual cost of $635 billion. 

Combat veterans as a population are disproportionately affected by chronic pain, according to a June 2014 report in the Journal of the American Medical Association’s Internal Medicine.

After combat deployment, 44 percent of U.S. military personnel experience chronic pain compared with a rate of 26 percent among the general public, according to the report.

Additionally, 15 percent of the U.S. military use opioids post-deployment, compared with a 4 percent rate of use among the general population.

“Elevated feelings of anxiety and depression may put veterans at risk for persistent pain and prolonged opioid use following surgery,” Huntley said.

Rakel said people suffering under those kinds of mental pressures, as many veterans do, might unintentionally inaccurately report their pain ratings, which could lead to the unnecessary prescription of opioids.

“Part of what the data will hopefully show is when opioid use can stop,” she said.

Workshops will consist of five to eight veterans, and Rakel hopes to host 12 one-day workshops over two years. 

She said workshops would instruct veterans in “acceptance and commitment therapy,” a tool that was originally developed for the treatment of veterans. 

This is one of the first times it has been used as a preventative treatment.

NIH awarded Rakel’s grant proposal $450,000 over the two-year period of the study. 

Huntley said grant proposals to the NIH endure a rigorous review process, with the highest rated projects receiving funding.

The amount Rakel received is a portion of $21.7 million granted by the institute to 13 projects based on nondrug approaches to pain management, PTSD, drug abuse and sleep disorders in veterans over the next five years.

Rakel said acceptance and commitment therapy is meant to work on the participants’ mindfulness.

Veterans will set personal goals by learning to recognize their own ineffective behaviors and responses to pain.  Psychologists then help participants create plans to actualize those goals.

“[Acceptance and commitment therapy] has been shown to reduce the amount of time drugs are needed,” Rakel said.

UI Assistant Professor of psychology Daryl Cameron said mindfulness is the process of becoming aware of your thoughts.

“The first step to changing behavior is becoming aware of what you’re trying to change,” he said.

Cameron said the process is controversial for some, who raise questions about the science of how, why, and when it works in patients. Though, according to some scienctists, there is evidence that the method can be effective.

“There is research showing that acceptance and commitment therapy can help to reduce distress and disability in patients with chronic pain,” Huntley said.

Workshop applicants will be compensated for their time and are screened to make sure they meet the criteria of the study. Participating veterans will then be randomly selected from a pool of approved names.

If the two-year feasibility study provides valuable data, the project may be brought in to large-scale human clinical trials.

“We hope that eventually, it is something that can be offered to everyone,” Rakel said.