Health Care Utilization After Interdisciplinary Chronic Pain Treatment: Part II. Preliminary Examination of Mediating and Moderating Factors in the Use of Costly Health Care Procedures

Military chronic musculoskeletal pain accounts for over $1 billion in health care and disability costs annually. Recent advances in the tertiary treatment of chronic pain for military service members have demonstrated significant benefit for military pain sufferers who complete an interdisciplinary functional restoration program. Functional restoration patients demonstrate significant improvements in mood, pain-related cognitions, physical functioning, self-efficacy, and rates of retention on active duty. Examination of data from the military's Armed Forces Health Longitudinal Technology Application (AHLTA) for active duty service members with chronic pain who completed the functional restoration FORT (Functional and Occupational Rehabilitation Treatment) program revealed that FORT patients sought significantly lower levels of costly medical procedures for pain compared to those who received treatment as usual. FORT participants were significantly less likely to seek treatment through the Emergency Department for pain, undergo injections for pain relief, or receive radio frequency nerve ablations for pain. This study was undertaken to identify relevant factors that contribute to reliance on costly medical procedures for pain relief among military service members with chronic musculoskeletal pain. Numerous psychosocial, physical, and demographic variables assessed as part of the FORT study were analyzed with AHLTA procedure data. This preliminary analysis revealed that service members without children (55%) were significantly more likely to seek medical procedures for pain compared to those with children (16%). Those who sought medical procedures for pain demonstrated significantly higher levels of work-related fear avoidance (x=21.83) compared to non-procedure patients (x=11.79), and those who received procedures also demonstrated less lumbar flexion (x=37.67 degrees) compared to non-utilizers (x=46.67 degrees). Lack of children, high work-related fear avoidance, and low lumbar range of motion accounted for 36% of the variance in medical procedure use in this sample. Implications for future research are discussed.