Optimizing Chronic Pain Management: Self-Care utilization among Veterans with Post-Traumatic Stress Disorder

Anamarie J. Lazo, University of San Diego
Paul Krug, University of San Diego
Joseph Burkard, University of San Diego
David Bittleman, VA San Diego Healthcare System


First of all, I would like to thank the Jonas Nursing and Veterans Healthcare Foundation for awarding me a Jonas Foundation Nurse Leader Scholarship for the school year 2016-2018. This scholarship provided me the inspiration and assistance I needed to pursue my dream of obtaining a doctorate degree from a prestigious school as University of San Diego (USD). Thank you to the USD faculty members who shared their expertise, knowledge, and experience to help me become a better clinician. I thank my faculty chair Dr. Joseph Burkard who supported my Evidence Based Practice Project and provided assistance in overcoming unforeseen challenges in regards to my project, thank you for your guidance. Also, to Major Paul Krug who collaborated with me on this project thanks for your patience and for being tech savvy.

Of course a big THANK YOU to my husband Mel who gave me great support through some challenging times during the last two years of school, thank you for staying up late with me most nights. Another heartfelt THANKS to my children Angela and Tommy whose continued encouragement inspire me to never give up, thank you for cheering me on. To the rest of my family and friends, thank you for believing in me!

I also want to take this opportunity to acknowledge my parents who instilled in me, at an early age, the importance of hard work, resilience and having passion to follow my dream and do what I love and never lose sight of my goal. Mostly, I THANK GOD for everything!

***What I am is God’s gift to me…what I make of myself is my gift to God***


Purpose: To implement a chronic pain management regimen that utilizes a self-care approach, integrating all dimensions of the biopsychosocial model to optimally treat the complex needs of younger Veterans with comorbid PTSD and chronic pain. The project aims to provide more insight and knowledge on safer chronic pain management among Veterans, reflected by improvement in patient’s pain level, quality of life, and depression scale.

Design: The project was implemented at the ASPIRE Center, a domiciliary residential rehabilitation treatment program for Veterans who suffer from PTSD and Traumatic Brain Injury. The 5A’s behavior change model was utilized during clinic visits and during follow-up phone calls. During each month’s clinic visit the provider and the Veteran discussed self-care modalities they thought would work best for them. Subsequent telephone follow-ups assessed the efficacy of the treatment and identified any barriers to treatment.

Results: The intervention gained modest improvements in pain level and quality of life, and a negative effect in depression symptoms. Results were affected by high drop-out rates as a result of irregular or unplanned discharges caused by multiple confounding factors. When surveyed post hoc, 97% of the participants felt the collaborative effort was beneficial.

Clinical Implications: Self-care utilization can provide a safe and effective way to manage chronic pain among Veterans with PTSD. This can be implemented in primary care and any site where effective chronic pain management is indicated. Overall, certain aspects of self-care interventions were effective in managing chronic pain.