• Gabriel Tan, Irene Teo, Devika Srivastava, Donna Smith, Shirley L Smith, Wright Williams, and Mark P Jensen.
• National University of Singapore, Singapore, Singapore. psygt@nus.edu.sg
• Pain Med. 2013 Jul 1;14(7):1010-20.

ObjectiveAccess to care has become a priority for the Veterans Administration (VA) health care system as a significant number of veterans enrolled in the VA health care system reside in rural areas. The feasibility and effects of a novel clinical intervention that combined group therapy and biofeedback training was evaluated on women veterans living in rural areas.MethodsThe study was conducted at selected community-based outpatient clinics (CBOCs) in Texas. Thirty four women veterans with chronic pain and comorbid depression and/or posttraumatic stress disorder (PTSD) were recruited. Five sessions of education/therapy were delivered via telemedicine in combination with daily home practice of a portable biofeedback device (Stress Eraser®, Helicor, New York, NY, USA). Participants responded to self-report questionnaires at baseline, at posttreatment, and at 6-week follow-up. Daily practice logs were also maintained by participants.ResultsThe clinical protocol was acceptable, easy to administer, and associated with statistically significant decreases in self-reported pain unpleasantness, pain interference, depressive symptoms, PTSD symptoms, and sleep disturbance at posttreatment. Improvements were maintained at 6-week follow-up. Qualitative analyses indicated that many participants 1) wished to continue to meet as a support group in their respective CBOCs and 2) felt less isolated and more empowered to cope with their problems of daily living as a result of the treatment.ConclusionsIt is feasible to provide treatment to women veterans living in rural areas by utilizing video-teleconferencing technology between larger VA medical centers and facilities at CBOCs in more rural settings. A controlled trial of the intervention is warranted.Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

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