Telehealth Program Helps Rural Women Veterans With Chronic Pain

Women veterans who live in rural areas face multifaceted challenges in managing chronic pain. Some barriers are logistical, including distance from health care facilities and the time required to get there, while others are financial, such as the cost of gas. Researchers from the Veterans Rural Health Resource Center and the Iowa City Veterans Affairs (VA) Health Care System designed a telehealth intervention specifically for rural women. What the study revealed was that social interactions and camaraderie may be just as important in reducing pain as gentle exercise and behavioral changes.

The participants, recruited from a Midwestern VA health care system, were dealing with chronic pain. In baseline measurements, average scores on the Pain, Enjoyment of Life, and General Activity three-item scale (PEG-3) indicated severe pain and functional interference. Notably, the researchers point out, rural women veterans with chronic pain are less likely than urban veterans to receive specialty pain care.

The researchers designed a program of pain self-management options, allowing the participants to sample from a range of empirically supported approaches in one easily accessible format. The program was primarily delivered over video, to support group processes as well as access to video-based components of the intervention (such as yoga lessons) or to display pages from the participant manual for in-session review. The researchers planned it as a women-only space, to provide a “psychologically safe, gender-sensitive, empowering environment.” 

Eight weekly 90-minute sessions featured mindful movement (gentle yoga, graduated walking), peer connection and support, and an introduction to an evidence-based pain or lifestyle self-management topic such as nutrition. The program also included content based on previous work in chronic pain including acceptance and commitment therapy, cognitive behavioral therapy, and dialectical behavior therapy.

Of the 44 participants, 84% completed the intervention. About half of treatment completers (47%) were deemed responders, reporting a ≥ 30% reduction on their PEG-3 total scores. On the Global Impression of Change scale, 87% reported improvement. 

Of the 30 participants who provided follow-up data, 94% were satisfied or very satisfied; no one reported being dissatisfied with the intervention. 

In qualitative interviews, though, the researchers say a clear theme emerged, reflecting the impact and benefit of the balance of three social and psychological components: rapport with facilitators, connection with other women veterans, and maintenance of individuality. 

In fact, the social support elements of the current intervention may have directly contributed to the observed improvements in pain severity and interference, the researchers suggest. They also cite another potential mechanism: impacting loneliness. Other studies have found that loneliness is prevalent among rural-dwelling women with chronic illnesses; research in rural settings also suggests that interventions focused on shared interests and common experiences might reduce loneliness. Moreover, reducing loneliness may have an independent benefit: In that research, loneliness was a risk factor for developing the pain, depression, and fatigue symptom cluster. 

The women in the telehealth study often spoke about the emotional benefits and camaraderie of the group sessions. They reported feeling understood. “The most memorable thing was that I just felt good,” one participant said. “…They helped me approach what was going on in my life. …[T]hey never grouped us together. We were all individuals with similar problems.”

Social support might help to buffer stress, which in turn may improve the experience of pain, via its effect on stressor appraisals and coping resources. Thus, their findings pair well, the researchers say, with the creation of the Women Veterans Network (WoVeN), a national peer-facilitated social support intervention aimed at ameliorating loneliness and increasing support among women veterans. Ultimately, they suggest, their findings may lead to help for women veterans living with chronic pain—whether they live in the country or the city.

Women veterans who live in rural areas face multifaceted challenges in managing chronic pain. Some barriers are logistical, including distance from health care facilities and the time required to get there, while others are financial, such as the cost of gas. Researchers from the Veterans Rural Health Resource Center and the Iowa City Veterans Affairs (VA) Health Care System designed a telehealth intervention specifically for rural women. What the study revealed was that social interactions and camaraderie may be just as important in reducing pain as gentle exercise and behavioral changes.

The participants, recruited from a Midwestern VA health care system, were dealing with chronic pain. In baseline measurements, average scores on the Pain, Enjoyment of Life, and General Activity three-item scale (PEG-3) indicated severe pain and functional interference. Notably, the researchers point out, rural women veterans with chronic pain are less likely than urban veterans to receive specialty pain care.

The researchers designed a program of pain self-management options, allowing the participants to sample from a range of empirically supported approaches in one easily accessible format. The program was primarily delivered over video, to support group processes as well as access to video-based components of the intervention (such as yoga lessons) or to display pages from the participant manual for in-session review. The researchers planned it as a women-only space, to provide a “psychologically safe, gender-sensitive, empowering environment.” 

Eight weekly 90-minute sessions featured mindful movement (gentle yoga, graduated walking), peer connection and support, and an introduction to an evidence-based pain or lifestyle self-management topic such as nutrition. The program also included content based on previous work in chronic pain including acceptance and commitment therapy, cognitive behavioral therapy, and dialectical behavior therapy.

Of the 44 participants, 84% completed the intervention. About half of treatment completers (47%) were deemed responders, reporting a ≥ 30% reduction on their PEG-3 total scores. On the Global Impression of Change scale, 87% reported improvement. 

Of the 30 participants who provided follow-up data, 94% were satisfied or very satisfied; no one reported being dissatisfied with the intervention. 

In qualitative interviews, though, the researchers say a clear theme emerged, reflecting the impact and benefit of the balance of three social and psychological components: rapport with facilitators, connection with other women veterans, and maintenance of individuality. 

In fact, the social support elements of the current intervention may have directly contributed to the observed improvements in pain severity and interference, the researchers suggest. They also cite another potential mechanism: impacting loneliness. Other studies have found that loneliness is prevalent among rural-dwelling women with chronic illnesses; research in rural settings also suggests that interventions focused on shared interests and common experiences might reduce loneliness. Moreover, reducing loneliness may have an independent benefit: In that research, loneliness was a risk factor for developing the pain, depression, and fatigue symptom cluster. 

The women in the telehealth study often spoke about the emotional benefits and camaraderie of the group sessions. They reported feeling understood. “The most memorable thing was that I just felt good,” one participant said. “…They helped me approach what was going on in my life. …[T]hey never grouped us together. We were all individuals with similar problems.”

Social support might help to buffer stress, which in turn may improve the experience of pain, via its effect on stressor appraisals and coping resources. Thus, their findings pair well, the researchers say, with the creation of the Women Veterans Network (WoVeN), a national peer-facilitated social support intervention aimed at ameliorating loneliness and increasing support among women veterans. Ultimately, they suggest, their findings may lead to help for women veterans living with chronic pain—whether they live in the country or the city.

Women veterans who live in rural areas face multifaceted challenges in managing chronic pain. Some barriers are logistical, including distance from health care facilities and the time required to get there, while others are financial, such as the cost of gas. Researchers from the Veterans Rural Health Resource Center and the Iowa City Veterans Affairs (VA) Health Care System designed a telehealth intervention specifically for rural women. What the study revealed was that social interactions and camaraderie may be just as important in reducing pain as gentle exercise and behavioral changes.

The participants, recruited from a Midwestern VA health care system, were dealing with chronic pain. In baseline measurements, average scores on the Pain, Enjoyment of Life, and General Activity three-item scale (PEG-3) indicated severe pain and functional interference. Notably, the researchers point out, rural women veterans with chronic pain are less likely than urban veterans to receive specialty pain care.

The researchers designed a program of pain self-management options, allowing the participants to sample from a range of empirically supported approaches in one easily accessible format. The program was primarily delivered over video, to support group processes as well as access to video-based components of the intervention (such as yoga lessons) or to display pages from the participant manual for in-session review. The researchers planned it as a women-only space, to provide a “psychologically safe, gender-sensitive, empowering environment.” 

Eight weekly 90-minute sessions featured mindful movement (gentle yoga, graduated walking), peer connection and support, and an introduction to an evidence-based pain or lifestyle self-management topic such as nutrition. The program also included content based on previous work in chronic pain including acceptance and commitment therapy, cognitive behavioral therapy, and dialectical behavior therapy.

Of the 44 participants, 84% completed the intervention. About half of treatment completers (47%) were deemed responders, reporting a ≥ 30% reduction on their PEG-3 total scores. On the Global Impression of Change scale, 87% reported improvement. 

Of the 30 participants who provided follow-up data, 94% were satisfied or very satisfied; no one reported being dissatisfied with the intervention. 

In qualitative interviews, though, the researchers say a clear theme emerged, reflecting the impact and benefit of the balance of three social and psychological components: rapport with facilitators, connection with other women veterans, and maintenance of individuality. 

In fact, the social support elements of the current intervention may have directly contributed to the observed improvements in pain severity and interference, the researchers suggest. They also cite another potential mechanism: impacting loneliness. Other studies have found that loneliness is prevalent among rural-dwelling women with chronic illnesses; research in rural settings also suggests that interventions focused on shared interests and common experiences might reduce loneliness. Moreover, reducing loneliness may have an independent benefit: In that research, loneliness was a risk factor for developing the pain, depression, and fatigue symptom cluster. 

The women in the telehealth study often spoke about the emotional benefits and camaraderie of the group sessions. They reported feeling understood. “The most memorable thing was that I just felt good,” one participant said. “…They helped me approach what was going on in my life. …[T]hey never grouped us together. We were all individuals with similar problems.”

Social support might help to buffer stress, which in turn may improve the experience of pain, via its effect on stressor appraisals and coping resources. Thus, their findings pair well, the researchers say, with the creation of the Women Veterans Network (WoVeN), a national peer-facilitated social support intervention aimed at ameliorating loneliness and increasing support among women veterans. Ultimately, they suggest, their findings may lead to help for women veterans living with chronic pain—whether they live in the country or the city.