title: Improving access to care for women veterans suffering from chronic pain and depression associated with trauma.
abstract: OBJECTIVE
  Access 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  It 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.
authors: National University of Singapore, Singapore, Singapore. psygt@nus.edu.sg
authors: Gabriel
authors: G
authors: Tan
authors: Irene
authors: I
authors: Teo
authors: Devika
authors: D
authors: Srivastava
authors: Donna
authors: D
authors: Smith
authors: Shirley L
authors: SL
authors: Smith
authors: Wright
authors: W
authors: Williams
authors: Mark P
authors: MP
authors: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D001676:Biofeedback, Psychology; D059350:Chronic Pain / Q000209:etiology* / Q000628:therapy*; D003142:Communication; D003866:Depressive Disorder / Q000209:etiology* / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D010147:Pain Measurement; D010353:Patient Education as Topic; D012424:Rural Population; D013315:Stress, Psychological / Q000628:therapy; D011795:Surveys and Questionnaires; D017216:Telemedicine; D013781:Texas / Q000453:epidemiology; D014728:Veterans; D014930:Women; D014947:Wounds and Injuries / Q000150:complications* / Q000523:psychology*; D055815:Young Adult
keywords: Biofeedback; Chronic Pain; Depression; Rural; Trauma; Women Veterans